定量脑电图联合经颅多普勒超声对动脉瘤蛛网膜下腔出血后迟发性脑缺血的预测价值研究  

Predictive Value of Quantitative EEG Combined with Transcranial Doppler Ultrasound on Delayed Cerebral Ischemia after Aneurysmal Subarachnoid Hemorrhages

作　　者：齐丽霞 李自如 姚远 朱润秀[1] QI Lixia;LI Ziru;YAO Yuan;ZHU Runxiu(Department of Neurology,Inner Mongolia People's Hospital,Hohhot 010017,China;School of Life Sciences,Inner Mongolia University,Hohhot 010070,China)

机构地区：[1]内蒙古自治区人民医院神经内科,内蒙古自治区呼和浩特市010017 [2]内蒙古大学生命科学学院,内蒙古自治区呼和浩特市010070

出　　处：《实用心脑肺血管病杂志》2022年第4期99-103,共5页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

基　　金：内蒙古自治区自然科学基金项目(2021MS08033);内蒙古自治区科技计划项目(2021GG0123)。

摘　　要：目的探讨定量脑电图(QEEG)联合经颅多普勒超声(TCD)对动脉瘤蛛网膜下腔出血(aSAH)后迟发性脑缺血(DCI)的诊断价值。方法选取2019年12月至2021年1月内蒙古自治区人民医院神经内科和神经外科收治的aSAH患者54例。以发病后14 d或出现DCI为观察终点,将患者分为DCI组16例和非DCI组38例。比较两组患者基线资料及入院后24 h内QEEG、TCD检查结果。aSAH患者发生DCI的影响因素分析采用多因素Logistic回归分析;并进一步绘制ROC曲线以评估α/δ比值(ADR)、大脑中动脉平均血流速度(Vm)及其联合对aSAH患者发生DCI的预测价值。结果两组患者改良Fisher分级、相对δ功率(RDP)、相对α功率(RAP)、ADR、相对α变异及大脑中动脉收缩期血流速度(Vs)、Vm、搏动指数(PI)比较,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,ADR〔OR=1.536,95%CI(1.046,2.257)〕及大脑中动脉Vm〔OR=2.543,95%CI(1.440,14.695)〕是aSAH患者发生DCI的影响因素(P<0.05)。ROC曲线分析结果显示,ADR联合大脑中动脉Vm预测aSAH患者发生DCI的AUC为0.946〔95%CI(0.888,1.000)〕,分别高于ADR〔AUC=0.844,95%CI(0.714,0.913)〕、大脑中动脉Vm〔AUC=0.771,95%CI(0.624,0.919)〕(P<0.05)。结论ADR、大脑中动脉Vm是aSAH患者发生DCI的影响因素,ADR联合大脑中动脉Vm对aSAH患者发生DCI的预测价值较高。Objective To investigate the diagnostic value of Quantitative electroencephalography(QEEG)combined with transcranial Doppler ultrasound(TCD)on delayed cerebral ischemia(DCI)after aneurysm subarachnoid hemorrhage(aSAH).Methods A total of 54 patients with aSAH admitted in the Department of Neurology and Neurosurgery of Inner Mongolia People's Hospital from December 2019 to January 2021 were selected.All patients were divided into DCI group(16 cases)and non-DCI group(38 cases),14 d after onset or DCI was used as the observation end point.The baseline data and the results of QEEG and TCD examination within 24 h after admission were compared between the two groups.The influencing factors of DCI in aSAH patients was analyzed by multivariate Logistic regression;ROC was further drawn to assess the predictive value of alpha/delta ratio(ADR),middle cerebral arterymean velocity(Vm)and their combination for DCI in patients with aSAH.Results There was statistically significant difference in modified Fisher grading,relative delta power(RDP),relative alpha power(RAP),ADR,relativeαvariants,and systolic velocity(Vs),Vm,pulsatility index(PI)of middle cerebral artery between the DCI group and the non-DCI group(P<0.05).The multivariate Logistic regression analysis showed that ADR[OR=1.536,95%CI(1.046,2.257)]and middle cerebral artery Vm[OR=2.543,95%CI(1.440,14.695)]were the influencing factors of DCI in aSAH patients(P<0.05).ROC curve analysis results showed that the AUC of ADR combined with middle cerebral artery Vm for predicting DCI in aSAH patients was 0.946[95%CI(0.888,1.000)],was higher than that of ADR[AUC=0.844,95%CI(0.714,0.913)]and middle cerebral artery Vm[AUC=0.771,95%CI(0.624,0.919)](P<0.05).Conclusion ADR and middle cerebral artery Vm are influencing factors of DCI in aSAH patients,and ADR combined with middle cerebral artery Vm has high predictive value for DCI in aSAH patients.

关 键 词：蛛网膜下腔出血 动脉瘤蛛网膜下腔出血 迟发性脑缺血 定量脑电图 经颅多普勒超声 预测 

分 类 号：R743.35[医药卫生—神经病学与精神病学]