脑电图反应性对急性重症脑血管病的预测意义  

The significance of electroencephalographic reactivity in prediction of critical cerebral vascular disease

作　　者：王琳[1] 宿英英[1] 李宁[1] 李淑娟[1] 

机构地区：[1]首都医科大学宣武医院神经内科重症监护治疗病房,北京100053

出　　处：《中华老年心脑血管病杂志》2002年第4期253-255,共3页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：北京市科学技术委员会科研基金资助 (95 3 3 0 40 0 3 )

摘　　要：目的　应用床边动态脑电图观察急性重症脑血管病患者的脑电图反应性 ,建立一种评价急性重症脑血管病脑功能损伤程度及预测预后的新方法。方法　选择格拉斯哥昏迷评分 (GCS) <8分或格拉斯哥 匹斯堡昏迷评分(GCS P) <2 7分的急性重症脑血管病患者 ,床边记录动态脑电图 ,判定刺激后脑电图 (EEG)反应性 ,同时记录GCS和GCS P。结果　双盲法判定EEG反应性的相符性 ,Kappa值 0 .82 3,GCS P评分与EEG反应性之间有很好的相关性。EEG反应性生存预测准确率 88.89% ,死亡预测准确率 72 .73%。GCS P评分生存预测准确率 6 6 .6 7% ,死亡预测准确率 72 .73%。EEG反应性和GCS P评分联合预测比单纯EEG反应性预测准确率没有明显提高。结论　EEG反应性判定标准临床可行。EEG反应性是急性重症脑血管病预后非常好的客观预测指标。EEG反应性预测准确率明显高于GCS P评分 ,尤其是生存预测准确率。Objectives To assess the reactivity of EEG in patients with critical cerebral vascular disease (CCVD) and to compare the reactivity of EEG to external stimuli with Glasgow coma scale (GCS) and Glasgow Pittsburgh coma scale(GCS P)in prediction of outcome of CCVD.Methods EEG reactivity,GCS and GCS P were measured in 20 patients with CCVD occurring 8-72 hours before admission,and only the patients with GCS<8,or GCS P<27 were enrolled.EEG reactivity and GCS P (GCS) were dynamically recorded at bedside.The interobserver agreement of EEG reactivity was assessed by the Kappa score determination.The correlation between EEG reactivity and GCS (GCS P) was analyzed by linear regression.Results Kappa score was 0.823,which demonstrated that the clinical application of EEG reactivity is feasible in the CCVD.The linear regression showed good correlation between EEG reactivity and GCS (GCS P).The rate of accurate prediction of survival was 66.67% with GCS P,88.89% with EEG reactivity and 88.89% with their combination.The rate of accurate prediction of death was 72.73% with GCS P,72.73% with EEG reactivity and 72.73% with their combination.Combination of EEG reactivity with GCS P did not further increase predictability.Conclusions EEG reactivity is an excellent outcome predictor in CCVD,superior to GCS P.When combined with GCS P,the prognostic accuracy is not better than that of EEG reactivity alone.

关 键 词：脑电图反应性 急性重症脑血管病 格拉斯哥昏迷量表 脑电描记术 脑损伤 脑功能损伤 预后 

分 类 号：R743.3[医药卫生—神经病学与精神病学]