振幅整合脑电图结合NIHSS评分对急性脑梗死患者近期预后的评估  

The value of amplitude--integrated electroencephalography on assessing the prognosis of the acute cerebral infarction

作　　者：麦晖[1] 周海红[1] 赵斌[1] 

机构地区：[1]广东医学院附属医院神经内科,524001

出　　处：《神经疾病与精神卫生》2013年第2期139-142,共4页Journal of Neuroscience and Mental Health

摘　　要：目的应用连续脑电图（continuouselectroencephalography，CEEG）观察急性期脑梗死患者振幅整合脑电图（amplitude—integratedelectroencephalography，aEEG）变化，探讨aEEG和NIHSS评分与急性脑梗死患者预后的关系。方法对70例符合急性脑梗死诊断标准的患者，采用脑电监护仪进行每次不少于24h动态脑电图、aEEG监测。分析其首次aEEG特点及结合NIHSS评分，探讨aEEG及NIHSS评分对预后的预测价值。结果（1）aEEG记录为正常、轻度异常、重度异常的急性脑梗死患者，近期预后不良率为57．69％、81．08％、100％（P〈o．05）。异常aEEG近期预后的灵敏度和特异度为71．2％，61．1％。（2）NIHSS评分为NIHSS〈9，9～16，〉16分的急性脑梗死患者，其近期预后不良率分别为17．65％，66．67％，100％（P〈0．01）。NIHSS评分指标不良（NIHSS≥9分以上）对患者近期预后不良的灵敏度和特异度分别为94．23％，77．8％。（3）aEEG分级、NIHSS评分两种方法预测急性脑梗死患者近期预后的比较，差异无统计学意义（P〉0．05）。aEEG分级与NIHSS评分相关系数r=0．299（P=0．012），aEEG分级与神经功能缺损呈正相关，aEEG分级越高，神经功能缺损越严重。结论对急性脑梗死患者近期预后，aEEG分级具有一定的预测价值，NIHSS评分具有明确的预测价值，aEEG结合NIHSS具有更好的价值，可为医疗决策提供客观依据。Objective To investigate the predictive value of aEEG combined with stroke assess- ment methods such as NIHSS in prognosis of the patients with acute cerebral infarction using continuous EEG （CEEG） and amplitude--integrated electroencephalogram （aEEG） monitoring. Methods Totals of 70 patients with acute cerebral infarction were monitored by aEEG. The duration of each aEEG monito- ring was at least 24 hours. The first time aEEG characteristics were analyzed and combined with NIHSS scores. Results （1） aEEG recordings of patients with acute cerebral infarction were divided into three groups, normal, mildly abnormal, and severe abnormalities, in which the percentage of patients with poor prognosis were 57.69 %, 81.08 %, and 100 % respectively （P ~ 0.05）. Sensitivity and specificity of abnormal aEEG （including mildly and severely abnormal aEEG） predicting poor outcome was 71.2 % and 61.1%. （2）NIHSS score of patients with acute cerebral infarction were divided into NIHSS%9,9- 16, 16 groups, in which the percentage of patients with poor prognosis were 17.65%, 66.67%, and 100% respectively （P〈0.01）. Sensitivity and specificity of NIHSS （NIHSS^9） predicting poor outcome was 94.23% ,77.8 %. （3） aEEG grade and NIHSS score were comparable in forecasting the prognosis （P = 0. 169）. Spearman correlation suggested there was a positive correlation between aEEG and degree of Neurologic deficits （r = 0.299, P = 0.012）. The more severe in abnormality of aEEG, the higher in the level of neurologic impairment. Conclusions It is meaningful to use aEEG as a tool to predict prognosis of patients with acute cerebral infarction. NIHSS is similarly useful to predict patients＇ prognosis, aEEG monitoring combined with NIHSS can reflect the variation of pathophysiological condition and provide objective evidence for medical decision making.

关 键 词：急性脑梗死 预后 美国国立卫生研究所脑卒中评分 振幅整合脑电图 

分 类 号：R743.33[医药卫生—神经病学与精神病学]