持续脑电双频指数监测对急性脑损伤患者预后的评估  

Evaluation of continuous monitoring of bispectral index in prognosis in patients with acute brain injury

作　　者：李海玲[1] 缪文丽[1] 任红贤[1] 林慧艳[1] 莎宁 

机构地区：[1]解放军第四0一医院ICU,山东青岛266071

出　　处：《中国危重病急救医学》2011年第6期352-354,共3页Chinese Critical Care Medicine

基　　金：山东省青岛市科技局课题（KZJ-14）

摘　　要：目的 探讨持续脑电双频指数（BIS）监测对急性脑损伤患者预后的评估作用.方法 采用回顾性研究方法,选择2009年3月至2010年7月重症监护病房（ICU）急性脑损伤昏迷患者61例,根据预后将患者分为生存组（25例）和死亡组（36例）.于入ICU 3 d内或停用镇静剂24 h后持续12 h监测BIS,取其均值（BISmean）、记录BIS最大值（BISmax）和最小值（BISmin）.记算患者急性生理学与慢性健康状况评分系统Ⅱ（APACHE Ⅱ）评分、存活概率（PS）、格拉斯哥昏迷评分（GCS）,并于监测当日取静脉血检测S100蛋白、神经元特异性烯醇化酶（NSE）水平;分析BISmean与GCS评分、$100蛋白、NSE水平的相关性.结果 ①两组患者性别、年龄、机械通气时间无明显差异.死亡组APACHE Ⅱ评分（分）明显高于生存组（27.36±5.99比23.28±6.69）,PS明显低于生存组（0.31±0.17比0.49±0.19）,住ICU时间（d）明显短于生存组（6.33±4.48比27.88±54.46）,P〈0.05或P〈0.01.②死亡组BISmean、BISmax、BISmin、GCS均明显低于生存组（BISmean：35.45±28.31比55.91±17.53,BISmax：51.92±34.24比74.84±16.58,BISmin：22.39±24.83比39.68±15.72,GCS评分（分）：3.64±1.19比5.60±2.22],P〈0.05或P〈0.01;血清S100蛋白、NSE水平明显高于生存组[S100蛋白（μg/L）：7.54±10.49比1.18±1.57,NSE（μg/L）：120.74±109.01比49.83±54.94],均P〈0.01.③双变量相关分析显示,BISmean与GCS评分呈显著正相关（r=0.379,P=0.003）,与S100蛋白、NSE水平呈显著负相关（r1=-0.418,P1=0.001;r2=-0.290,P2=0.023）.结论 BIS监测具有无创、直观、易于操作、可连续监测的特点,可以作为判断急性脑损伤患者预后的早期客观指标.Objective To discuss the effect of continuous monitoring of bispectral index（BIS）on the prognosis of patients with acute brain injury.Methods A retrospective study was carried out,61 patients with acute brain injury admitted to the intensive care unit （ICU） from March 2009 to July 201 0 were divided into survival group （n=25） and death group （n=36）.The BIS was continuously monitored for 12 hours within the first 3 days or 24 hours after stoppage of sedative after admission to ICU.The mean value of BIS （BISmean）,the maximal value of BIS（BISmax）,and the minimal value of BIS（BISmin）were evaluated.At the same time,the acute physiology and chronic health evaluation Ⅱ （APACHE Ⅱ） score,probability of survival （PS） and Glasgow coma score （GCS） were evaluated.The values of serum S100 protein and neuron-specific enolase （NSE） were determined.The relationship between BISmean and GCS,S100 protein and NSE were respectively analyzed.Results ①There was no significant difference in the sex,age,or duration of mechanical ventilation between two groups.APACHE Ⅱ score in death group was significantly higher than the survival group （27.36±5.99 vs.23.28±6.69）,PS was significantly lower than the survival group（0.31±0.17 vs.0.49±0.19）,and length of stay in ICU （days） was significantly lower than that of the survival group（6.33±4.48 vs.27.88±54.46）,P〈0.05 or P〈0.01.②BISmean,BISmax,BISmin,GCS in death group were significantly lower than those in the survival group （BISmean：35.45±28.31 vs.55.91±17.53,BISmax：51.92±34.24 vs.74.84±1 6.58,BISmin：22.39±24.83 vs.39.68±15.72,GCS score：3.64±1.19 vs.5.60±2.22）,P〈0.05 or P〈0.01,while serum S100 protein and NSE levels were significantly higher than the survival group（S100 protein（μg/L）：7.54±10.49 vs.1.18±1.57,NSE （μg/L）：120.74±109.01 vs.49.83±54.94],both P〈0.01.③By bivariate analysis,BISmean was positively correlated with GCS（r=0.379,P=0.003）,whereas it was found to be n

关 键 词：脑电双频指数 脑损伤 急性 预后 

分 类 号：R651.15[医药卫生—外科学]