中潜伏期体感诱发电位预测重症脑卒中患者预后的应用价值  

Evaluate using of middle-latency somatosensory evoked potentials in predicting outcomes of patients with severe stroke

作　　者：张艳[1] 宿英英[1] 肖淑英[1] 

机构地区：[1]首都医科大学宣武医院神经内科,北京100053

出　　处：《中华神经科杂志》2011年第1期38-42,共5页Chinese Journal of Neurology

基　　金：基金项目：首都医学发展科研基金资助项目（2007-1043）

摘　　要：目的探讨中潜伏期体感诱发电位（middle—latencysomatosensoryevokedpotentials．MLSEP）预测急性重症脑卒中患者预后的应用价值。方法对70例症状出现7d内的重症脑卒中患者行格拉斯哥昏迷评分（GlasgowComaScale，GCS）、短潜伏期体感诱发电位（short—latencysomatosensoryevokedpotentials，SLSEP）和MLSEP检测，6个月后采用改良Rankin评分和生存与死亡两个预后标准进行预后评估。健康对照组20名行SLSEP和MLSEP检测。统计学分析MLSEP、SLSEP和GSC与预后的一致性及预测的准确性。结果健康对照组均记录到双侧N20、N35和N60，脑卒中组患者MLSEP波形有缺失，而且病灶侧MLSEP各波消失比例明显高于对侧。双侧NSO消失与预后不良（Kappa=0．828，P〈0．01）和死亡（Kappa=0．686，P〈0．01）的一致性均最好。预测准确性分析显示：病灶侧N60消失预测不良预后和死亡的敏感性高达100％，较病灶侧N20消失的敏感性（85．7％）提高了14．3％；双侧N60消失预测预后不良的特异性为100％，与双侧N20消失一致；但预测死亡的特异性为82．9％，不如双侧N20消失（97．1％）。结论MLSEP可反映脑损伤程度，预测预后不良的敏感性高于SLSEP，建议将MLSEP和SLSEP联合用于重症脑损伤后的评估与预后的预测。Objective To explore the effectiveness of using middle-latency somatosensory evoked potentials （MLSEP） to predict the prognosis in patients with acute severe stroke. Methods MLSEP, shortlatency somatosensory evoked potentials （SLSEP）, and Glasgow Coma Scale （GCS） were recorded in 70 acute severe supratentorial stroke patients within 1 week after onset. All patients were evaluated with modified Rankin Scale （mRS） and follow-up in 6 months after onset. SLSEP and MLSEP were recorded in 20 normal controls. The consistency between MLSEP, SISEP, GCS and prognosis, as well as the prognostic authenticity of MLSEP, SLSEP, and GCS were analyzed. Results Bilateral N20, N35, and N60 exited in all normal controls. Some waves of MLSEP were absent in stroke patients, and the proportion of absent waves in ipsilateral MLSEP was higher than in contralateral MLSEP. The consistency between bilateral absence of N60 and unfavorable outcome （Kappa =0. 828,P 〈0. 01 ）, and between bilateral absence of N60 and death （ Kappa = 0. 686, P 〈 0. 01 ） was satisfactory. By using the prognostic authenticity analysis of predictors, the ipsilateral absence of N60 showed the highest sensitivity （ 100% ） for unfavorable outcome and death, which added 14. 3% compared with the sensitivity of ipsilateral absence of N20 （85.7%）. Bilateral absence of N60 showed a high specificity of 100% for unfavorable outcome, which equaled bilateral absence of N20. However, it showed a lower specificity （82.9%） for death, than bilateral absence of N20 （97. 1% ）. Conclusions MLSEP was able to reflect the degree of brain injury and showed higher sensitivity than SLSEP for predicting unfavorable outcomes. Therefore combined use of MLSEP and SLSEP in evaluating and predicting the outcomes in brain injuries is suggested.

关 键 词：卒中 诱发电位 躯体感觉 格拉斯哥昏迷量表 预后 

分 类 号：R743.3[医药卫生—神经病学与精神病学]