体感诱发电位在重型颅脑损伤长期意识障碍患者清醒预测中的作用  

Predictive value of short-latency somatosensory evoked potentials for awakening in long-term unconscious patients after severe traumatic brain injury with.

作　　者：徐伟伟[1] 王向宇[1] 姜晓丹[1] 周月玲[2] 柯以铨[1] 

机构地区：[1]南方医科大学珠江医院神经外科,广州510282 [2]珠江医院神经内科脑电图室

出　　处：《中国神经精神疾病杂志》2010年第6期331-334,共4页Chinese Journal of Nervous and Mental Diseases

摘　　要：目的探讨重型颅脑损伤(traumatic brain injury,TBI)后长期意识障碍成人患者清醒的影响因素及清醒预测。方法收集47例重度颅脑损伤后(Glasgow coma scale,GCS<8)意识障碍超过2周的患者的病例资料,选择5个预后因子:年龄、性别、受伤机制、去骨瓣减压手术、体感诱发电位(somatosensory evoked potentials,SEP)表现方式等分析与清醒结果的关系,将体感诱发电位分为3个等级:Ⅰ级,双侧N20-P25都存在,①双侧CCT正常且对称,N20-P25波幅正常;②至少一侧CCT延长低于其正常均值一倍且N20-P25波幅>0.8μV。Ⅱ级,至少有一项达到下列指标,①双侧CCT延长超过其正常均值一倍;②双侧N20-P25波幅<0.8μV;③一侧N20-P25消失,另一侧存在。Ⅲ级,双侧N20-P25消失。结果判定以外伤后6个月患者是否清醒为标准。结果 SEP分级与重型颅脑损伤长期意识障碍患者清醒的机率有显著相关性(P=0.002),其对清醒的预测准确率可达87.2%。结论 SEP分级可客观、准确地评估患者的预后及预测患者的清醒机率。Objective To study the predictive value of short-latency somatosensory evoked potentials（SEP） for awakening of unconscious adult patients after severe TBI（traumatic brain injury,TBI）.Methods Five prognostic factors including age,sex,mechanisms of injury,history of temporal craniectomy,and classification of SEP were selected and analyzed in 47 patients suffering from severe TBI（GCS 8） with duration of disorders of consciousnessness 2 weeks.SEP was classified into three grades according to the existence of N20-P25 complex wave and CCT（central conduction time,CCT） as following： GradeⅠ： Bilateral N20-P25 complex waves exist：（1）Bilateral CCT and amplitude of N20-P25 are normal and symmetrical;（2）Unilateral or bilateral CCT delays less than twice as long as normal,and at least unilateral amplitude of N20-P25 more than 0.8μV.Grade Ⅱ：（1） Bilateral CCT delays more than twice as long as normal;（2） Bilateral amplitudes of N20-P25 less than 0.8μV;（3） Unilateral N20-P25 complex wave exists,the other side absent.Grade Ⅲ： Bilateral N20-P25 complex waves absent.The outcome of awakening after the sixth month following injury was used as the criterion.Results The SEP classification significantly correlated with the probabilities of awakening（P=0.002） and the accuracy of predicting the outcome of awakening is 87.2%.Conclusions The SEP classification can objectively and accurately evaluate the patient＇s prognoses and predict the probabilities of patients＇ awakening.

关 键 词：体感诱发电位 颅脑损伤 意识障碍 清醒预测 

分 类 号：R651.1[医药卫生—外科学]