诱发电位预测重症脑卒中患者不良预后时机研究  

Timing of evoked potentials forecasting the prognosis of severe stroke patients

作　　者：肖淑英[1] 宿英英[1] 张艳[1] 赵红[1] 庞英[1] 刘祎菲 

机构地区：[1]首都医科大学宣武医院神经内科重症监护病房,北京100053

出　　处：《中国现代神经疾病杂志》2015年第12期944-949,共6页Chinese Journal of Contemporary Neurology and Neurosurgery

基　　金：国家临床重点专科建设项目-神经内科;国家临床重点专科建设项目-重症医学科;国家高技术研究发展计划(863计划)项目(项目编号:2015AA020514)~~

摘　　要：目的探讨短潜伏期体感诱发电位（SLSEP）和脑干听觉诱发电位（BAEP）预测急性重症脑卒中患者预后的最佳时机。方法以Glasgow昏迷量表（GCS）评分≤12分并经头部CT和（或）MRI检查证实的幕上大面积梗死或大容积出血患者作为观察对象,分别于发病后第1~3和4~7天行GCS评分、SLSEP和BAEP检查;并于发病后6个月采用改良Rankin量表（m RS）评估预后,分析发病后不同时间窗预测指标（GCS评分、SLSEP和BAEP）与预后评估指标（m RS评分）之间的关联性和预测准确性。结果（1）关联性分析：发病第1~3天,GCS评分、SLSEP和BAEP与m RS评分之间无关联性（均P〉0.05）;发病第4~7天,SLSEP和BAEP与m RS之间存在关联性（均P〈0.01,C〉0.400）。（2）预后预测准确性分析：发病第4~7天,SLSEP和BAEPⅤ波预测灵敏度为85.71%~97.62%、BAEP特异度为80.00%~90.00%,各项预测指标阳性预测值达89.13%~96.88%、SLSEP阴性预测值为83.33%~85.71%,其中SLSEP和BAEP预测准确度均达临床预期,尤以SLSEP最佳（88.46%~90.38%）。结论急性重症脑卒中患者发病第4~7天SLSEP和BAEP预测不良预后的准确性较高。ObjectiveTo investigate the best assessment time of short- latency somatosensory-evoked potential（SLSEP） and brain stem auditory- evoked potential（BAEP） in predicting the prognosis ofpatients with acute severe stroke.MethodsFifty- two patients who were diagnosed as supratentorialmassive cerebral infarction or large-volume cerebral hemorrhage by brain CT and/or MRI examination withGlasgow Coma Scale（GCS） ≤ 12 were selected as observation subjects. GCS, SLSEP and BAEP wererecorded at 1-3 and 4-7 d after onset. Outcomes were examined 6 months later using the modified RankinScale（m RS）. A m RS score of 0-4 was considered as favorable outcome while a score of 5-6 wasconsidered as unfavorable. The correlation between different predictive indexes（GCS, SLSEP and BAEP）and outcome（m RS） was analyzed. The predictive accuracy was also analyzed.ResultsAt 1-3 d afteronset, there was no correlation between all the predictors and outcome（P 0.05, for all）. At 4-7 d afteronset, SLSEP and BAEP were significantly correlated with m RS（P 0.01, for all; C 0.400）. At 4-7 dafter onset, the prognostic sensitivity of SLSEP and BAEP Ⅴ wave was 85.71%-97.62%; prognosticspecificity of BAEP was 80.00%-90.00%; positive predictive value of all predictors was 89.13%-96.88%;negative predictive value of SLSEP was 83.33%-85.71%; total predictive accuracy of SLSEP was88.46%-90.38%. The predictive accuracy of both SLSEP and BAEP achieved the clinical expectation, andthe former is better than the latter.ConclusionsSLSEP and BAEP have a high accuracy rate inpredicting the unfavorable prognosis of patients with acute severe stroke 4-7 d after onset.

关 键 词：卒中 诱发电位 躯体感觉 诱发电位 听觉 脑干 预后 敏感性与特异性 

分 类 号：R743.3[医药卫生—神经病学与精神病学]