诱发电位评估重症脑血管病患者预后时间窗研究  

Timing of evoked potentials forecasting the prognosis of patients with severe cerebrovascular disease

作　　者：张金聪[1] 孙世中[2] 王东[1] 迟凯扬 汤锋武[3] 赵永青[4] 

机构地区：[1]天津中医药大学,300100 [2]武警后勤学院附属脑科医院NICU,天津300171 [3]武警后勤学院附属脑科医院脊髓脊柱外科 [4]武警后勤学院附属脑科医院神经内一科

出　　处：《中华危重病急救医学》2016年第12期1135-1140,共6页Chinese Critical Care Medicine

基　　金：国家重点研发计划课题（2016YFC1101504）

摘　　要：目的探讨上肢体感诱发电位（SLSEP）和脑干听觉诱发电位（BAEP）评估重症脑血管病患者预后的有效性及敏感时间窗。方法采用前瞻性研究方法，选择2014年12月至2015年5月人住武警后勤学院附属脑科医院神经重症加强治疗病房（NICU）格拉斯哥昏迷评分（GCS）≤8分的重症脑血管病患者作为观察对象，分别于人院后24h内和3、7、15d4个时间窗进行SLSEP和BAEP神经电生理学检查，并参照Cant法进行分级；于入院后24h内和15d进行GCS评分；发病后6个月采用格拉斯哥预后评分（GOS）评估预后；Spearman秩相关分析发病后不同时间窗GCS、SLSEP和BAEP等评估指标与预后指标GOS之间的相关性；绘制各评估指标对预后预测的受试者工作特征曲线（ROC），比较各评估指标及其联合评估的有效性。结果人选78例患者，男性46例，女性32例；年龄（60．79±12．50）岁；因部分患者短期死亡，入院24h内和3、7、15d进行检测的患者分别有78、64、44、19例；SLSEP分级异常率分别为75．64％、82．81％、79．55％、73．98％；BAEP分级异常率分别为82．05％、84．38％、85．94％、73．68％。①关联性分析：人院24h内及3、7、15d各评估指标与GOS均具有关联性，且SLSEP、BAEP分级与GOS均呈中度相关（0-4≤IRI〈0．7）。②评估预后的准确性：当预测生存时，15dGCS的ROC曲线下面积（AUC）最大[AUC=0．772，95％可信区间（95％CI）=0．561-0．984，P=0．045]；当预测死亡时，入院7dSLSEP、BAFP分级的AUC均最大（SLSEP的AUC=0．825，95％CI=0．695。0．955，P=0．000；BAEP的AUC=0．786，95％CI=0．646-0．927，P=0．002）。③评估预后的有效性：发病7d时，SLSEP、BAEP分级的敏感度较高，分别为92．6％、96．3％，而SLSEP与BAEP联合评估的敏感度、特异度、准确率均达100％；入院15dGCS的特异度为100％。结论相较于GCS，SLSEP、BAEP与预后的关联性更密Objective To investigate the effectiveness and the best assessment time of the short-latency somatosensory evoked potential （SLSEP） and brainstem auditory-evoked potential （BAED in the prognosis prediction of patients with severe eerebrovascular disease. Methods A prospective trial was conducted. The patients with severe cerebrovascular disease and Glasgow coma scale （GCS） ≤ 8 and admitted to the neurological intensive care unit （NICU） of Armed Police Logistics College Affiliated Brain Hospital from December 2014 to May 2015 were enrolled. The patients received SLSEP and BAEP nerve electrophysiological examinations within 24 hours and on 3, 7, 15 days after admission respectively and were graded according to Cant method. GCS was evaluated within 24 hours and on 15 days after admission. The prognosis was evaluated by Glasgow outcome scale （GOS） at six months after the onset of the disease. At different time windows after the onset of the disease, the correlations between different predictive indexes （GCS, SLSEP and BAEP） and outcome （GOS） were analyzed using spearman rank correlation; in the mean time, the efficacy for predicting the prognosis by single index or combined indexes was compared by receiver operator characteristic （ROC） curve. Results Seventy-eight patients were enrolled [men 46, women 32, age range （60.79± 12.50） years old]. There were 78, 64, 44 and 19 patients observed at 24 hours and on 3, 7, 15 days after admission because the short-term death of some patients. The graded abnormal rate of SLSEP was 75.64%,82.81%, 79.55% and 73.98% respectively; and the graded abnormal rate of BAEP was 82.05%, 84.38%, 85.94% and 73.68% respectively. ①Correlation analysis： all the predictors were correlated with GOS within 24 hours and on 3, 7, 15 days after admission, and SLSEP and BAEP grading were moderately correlated with GOS （0.4 ≤ IRI 〈 0.7）. ② The accuracy of the predicting prognosis： the area under the curve （AUC） of GCS on 15 days after admission [A

关 键 词：脑血管病 重症 上肢体感诱发电位 脑干听觉诱发电位 格拉斯哥昏迷评分 格拉斯哥预后评分 预后评估 准确性 敏感性 特异性 

分 类 号：R743[医药卫生—神经病学与精神病学]