脑电图和脑干听觉诱发电位动态检测对急性一氧化碳中毒后迟发性脑病的预测价值研究  

Electroencephalogram and Brainstem Auditory Evoked Potential Determining Dynamically Delayed Encephalopathy after Acute Carbon Monoxide Poisoning

作　　者：王传升[1] 张萍[1] 韩永凯[1] 穆俊林[1] 顾家鹏 时婷婷[1] 赵建民[2] 吴强[2] 赵建华[3] 石金河[3] 靳玫[4] 顾仁骏[1] 

机构地区：[1]新乡医学院第二附属医院,河南省新乡市453002 [2]新乡市中心医院 [3]新乡医学院第一附属医院 [4]新乡医学院第三附属医院

出　　处：《中国全科医学》2013年第17期1945-1948,共4页Chinese General Practice

基　　金：河南省科技厅科技攻关计划资助项目(0624410035);河南省卫生科技创新人才资助项目(3052)

摘　　要：目的观察急性一氧化碳(CO)中毒患者清醒后脑电图(EEG)及脑干听觉诱发电位(BAEP)的动态变化,探讨二者对急性CO中毒后迟发性脑病(DEACMP)发病的预测价值。方法选取2006年2月—2010年12月在新乡医学院第一、第二、第三附属医院及新乡市中心医院住院治疗的急性CO中毒昏迷且经抢救清醒的患者83例,根据患者是否出现DEACMP将其分为DEACMP组(32例)及非DEACMP组(51例)。患者分别于急性中毒清醒后1～5 d、8～12 d、18～22 d、28～32 d、38～42 d及52～57 d进行6次EEG和BAEP检测,比较不同时点DEACMP组及非DEACMP组EEG、BAEP异常率,计算EEG、BAEP单独检测及二者联合检测预测DEACMP的敏感度、特异度。结果 (1)DEACMP组第1次、第4次、第5次、第6次EEG检测异常率均高于非DEACMP组,差异有统计学意义(P<0.05);DEACMP组第1次、第3次、第4次、第5次、第6次BAEP检测异常率均高于非DEACMP组,差异有统计学意义(P<0.01)。(2)83例急性CO中毒患者首次EEG检查共58例(69.9%)异常,其中27例发展为DEACMP。EEG检测预测DEACMP的敏感度为84.4%(27/32),特异度为39.2%(20/51)。首次BAEP检查共23例(27.7%)异常,其中19例发展为DEACMP。BAEP检查预测DEACMP的敏感度为59.4%(19/32),特异度为92.2%(47/51)。EEG联合BAEP检测,若其中一项阳性即视为阳性,则联合检测预测DEACMP的敏感度为93.7%,特异度为36.1%;若二者均为阳性时才视为阳性,则联合检测预测DEACMP的敏感度为50.1%,特异度为95.2%。动态EEG测定或BAEP测定若出现异常-好转-重新异常的情况,则高度预示DEACMP的发生。结论急性CO中毒后早期动态检测EEG及BAEP对预测DEACMP的发生具有重要意义和临床价值,值得推广应用。Objective To observe the dynamic changes of electroencephalogram （EEG） and brainstem auditory e-voked potential （BAEP） in patients with acute carbon monoxide poisoning （ACMP）, to find out their predictive values for de-layed encephalopathy after acute carbon monoxide poisoning （DEACMP）. Methods A total of 83 acute carbon monoxide poi-soning （ACMP） patients were divided, according to occurrence of DEACMP, into groups DEACMP （n = 32） and non - DEACMP （n=51）. Patients were given EEG and BAEP on days 1-5, 8-12, 18 -22, 28-32, 38-42, 52-57. The abnormal rates of EEG, BAEP at different time points were compared, and the sensitivity and specificity of EEG, BAEP or of their combination calculated in predicting DEACMP. Results The abnormal rates of the 1st, 4th, 5th, 6th EEG were significantly higher in DEACMP group than those in non - DEACMP group （ P 〈 0.05 ） ; The abnormal rates of the 1st, 3rd, 4th, 5th, 6th BAEP higher in DEACMP group than in non - DEACMP group （ P 〈 0.01 ）. The first EEG was abnormal in 58 patients （ 69. 9% ）, including 27 patients who developed to DEACMP. The sensitivity of EEG predicting DEACMP was 84.4% （27/32）, specificity was 39. 2% （20/51）. The first BAEP was abnormal in 23 patients （27.7%）, including 19 pa-tients who developed to DEACMP. The sensitivity of BAEP predicting DEACMP was 59. 4% （19/32）, specificity was 92. 2% （47/51）. The sensitivity of EEG combined with BAEP was 93.7%, if 1 item being positive was taken as positive, the sensitivi- ty was 93.7%, specificity was 36. 1% ; If 2 items being positive was taken as positive, the sensitivity was 50. 1%, specificity was 95.2%. Dynamical EEG or BAEP showing condition of abnormality - improvement - reabnormality predicted highly the inci-dence of DEACMP. Conclusion Early dynamical EEG and BAEP are of great significance and clinical values after ACMP, which is worth popularizing and applying.

关 键 词：一氧化碳中毒 迟发性脑病 脑电图 诱发电位 听觉 脑干 

分 类 号：R749.63[医药卫生—神经病学与精神病学]