脑干听觉诱发电位分级对脑创伤长期意识障碍患者清醒预测的价值  

Evaluation in prediction of outcome of awakening in unconscious patients after traumatic brain injury by new brainstem auditory evoked potential grading

作　　者：谢成金[1] 王向宇[1] 陈燕伟[1] 包赟[1] 林鸿[1] 

机构地区：[1]南方医科大学珠江医院神经外科,广东神经医学研究所,广州510282

出　　处：《中华神经外科杂志》2011年第11期1095-1098,共4页Chinese Journal of Neurosurgery

摘　　要：目的探讨脑干听觉诱发电位（BAEP）分级标准对脑创伤后长期意识障碍患者清醒预测的价值。方法分析93例脑创伤后长期意识障碍患者的BAEP表现，将BAEP分为3级：Ⅰ级为各波均正常；Ⅲ级为双侧Ⅴ波PL异常、双侧Ⅲ-Ⅴ波IPL异常、单侧或双侧V波消失；Ⅱ级为除Ⅲ级之外的任何异常BAEP表现。以脑创伤后6个月作为判断是否清醒的时间标准。结果Ⅰ级、Ⅱ级、Ⅲ级的清醒率分别为：79％、18％和0％。分级与清醒差异有统计学意义（r=-0．662，P〈0．001），分级越高，清醒越困难。BAEP分级标准对清醒预测的ROC曲线下面积为0．859，95％可信区间为（0．781—0．937）。结论BAEP分级能客观、准确地反映脑功能损伤程度和预测清醒的概率。Objective To explore the value of new brainstem auditory evoked potential grading in prediction of awakening in unconscious patients after traumatic brain injury （ TB1 ）. Method BAEPs were recorded and analyzed in 93 patients suffering from TBI with duration of disturbance of BEAPs were classified into three grades： Grade- all BEAP findings were normal;Grade Ⅲ -bilateral PL of wave Vor IPL of wave Ⅲ-Ⅴ were abnormal,unilateral or bilateral wave Ⅴ were absent;Grade Ⅱ - any abnormal BAEPs except Grade m, including unilateral or bilateral peak latency（PL） of waveI,lll, inter peak latency（IPL） of wave Ⅰ - Ⅲ or amplitude ratio of waveIand Ⅴwere abnormal, or unilateral PL of wave Ⅴ or IPL of wave Ⅲ-Ⅴ were abnormal. Conscious or unconscious at the 6th month after injury was considered as the outcome criterion. Results The new grading standards showed grade ,Ⅰ,Ⅱand Ⅲ have 79%, 18% and 0% of patients awaking at the 6th month. The new BAEP grading standards had significant correlation with the probabilities of awakening （ r = -0. 662, P 〈0. 001 ; The higher the grades,the lower the probability of awakening）. The area under the ROC curve was O. 859 and 95% confidence interval was （0. 781 -0. 937） of awakening prediction using BAEP classification standard. Conclusions New BAEP grading could demonstrate cerebral dysfunction and probabilities of patients＇ awakening objectively and accurately.

关 键 词：颅脑损伤 意识障碍 清醒预测 脑干听觉诱发电位 

分 类 号：R651.15[医药卫生—外科学]