视频脑电监测在术后意识障碍的鉴别价值  

Identifying value of VEEG monitoring in neurosurgery patients with postoperative consciousness disability

作　　者：方升[1] 詹彦[1] 崔荣周[1] 石全红[1] 谢延风[1] 王超[1] 熊伟茗[1] 夏湘平[1] 王佳[1] 但炜[1] 

机构地区：[1]重庆医科大学附属第一医院神经外科,400016

出　　处：《中华神经外科杂志》2012年第12期1230-1234,共5页Chinese Journal of Neurosurgery

摘　　要：目的讨论视频脑电监测在鉴别开颅术后非惊厥性癫痫持续状态（PONES）与术后应用丙戊酸钠所致高氨血症性脑病（VHE）的价值。方法回顾性分析8例开颅术后意识障碍的患者，经头颅CT、心电图、电解质、血糖及血气分析等检查，排除常见原因所致意识障碍，行视频脑电监测及血氨、丙戊酸钠血药浓度检测，诊断为PONES3例，VHE5例。比较两种疾病的脑电变化特征。结果3例PONES患者脑电图显示：间歇性全脑同步暴发痫样放电，丙戊酸钠血药浓度略低于治疗量，肝功及血氨正常。5例VHE患者脑电图显示：广泛性背景脑电抑制，各导联散在三相波增多，血氨明显升高，肝功正常，丙戊酸钠血药浓度略高于治疗范围。PONES组加大丙戊酸钠用量；VHE组停用丙戊酸钠并加精氨酸降血氨治疗后，脑电明显改善，意识恢复。结论视频脑电监测是诊断PONES的特异性检查，对开颅术后PONES与VHE具有重要的鉴别价值。Objective To explore the practical value of continuous video - electroencephalograph （VEEG） monitoring on differentiating the diagnosis between postoperative nonconvulsive encephalopathic status （PONES） and valproate -induced hyperammonemic encephalopathy （VHE）, caused by using valproate, after a craniotomy. Methods Eight patients that underwent craniotomy and had problems with postoperative disturbance of consciousness were retrospectively analyzed. The common reasons for disturbance of consciousness were excluded by routine examinations, such as brain CT scan, electrocardiogram, electrolytic analysis, hepatic function, blood sugar analysis, blood gas analysis, etc. VEEG monitoring and detection on blood ammonia （BA） and valproate （VPA） drug concentration were detected. The patients were diagnosed as three PONES and five VHE. Then, the comparison of characteristics in the EEG changes for the two diseases was preformed. Results In the eight patients, three PONES patients＇ VPA drug concentration was slightly lower than the therapeutic dose, while their hepatic function and blood ammonia were in the normal ranges. VEEG monitoring showed that intermittent bursts of generalized epileptic discharge were taking place in the whole brain. When the VPA dose was increased, the patients＇ consciousness was improved significantly and VEEG showed a significant decrease on epileptic discharge. The five VHE patients had a significant increase in their blood ammonia concentration, while their hepatic function was in the normal range and VPA drug concentration was slightly higher than the normal range. EEG monitoring showed generalized inhibition on brain electrical activity and an increase of repetitive triphasic waves. When VPA treatment was stopped and arginine was given, the patients＇ blood ammonia concentration went down, and their EEG recovered to a normal rhythm while consciousness also recovered rapidly. Conclusions VEEG is a specific examination for diagnosing PONES, which provides great value on

关 键 词：丙戊酸钠 丙戊酸钠致高氨血症性脑病 血氨 视频脑电图 术后非惊厥性 癫痫持续状态 

分 类 号：R742.1[医药卫生—神经病学与精神病学]