经颅多普勒屏气试验联合定量脑电图在急性脑梗死认知评估中的应用价值  

The Application Value of TCD Breath-holding Test Combined with QEEG in Cognitive Assessment with Acute Cerebral Infarction

作　　者：何庆芳 周红 HE Qingfang;ZHOU Hong(Department of Neurology,Shengze Hospital Affiliated to Nanjing Medical University,Suzhou City,Jiangsu Province 215000)

机构地区：[1]南京医科大学附属江苏盛泽医院神经内科,江苏省苏州市215000

出　　处：《医学理论与实践》2022年第22期3792-3795,3784,共5页The Journal of Medical Theory and Practice

基　　金：苏州市吴江区“临床医学专家团队”引进项目(WJYJTD201802);苏州市吴江区“科教兴卫”项目(WWK201716);江苏盛泽医院院级科研项目(SYK201807)。

摘　　要：目的:通过经颅多普勒超声(TCD)屏气试验联合定量脑电图(QEEG)检测对急性脑梗死(ACI)患者进行认知评估,以发掘两者在急性脑梗死认知功能中的应用价值。方法:为前瞻性研究,选取在我院住院的ACI患者58例作为观察组,以及同期体检者45例作为对照组,对两组对象进行TCD屏气试验及QEEG检测,得到BHI值、Vm上升率、DTABR值,并对两组对象进行MoCA量表评定,通过发病6个月MoCA量表分值将观察组分为认知障碍组(MoCA评分<26分)15例及正常认知组(MoCA评分≥26分)43例,并对两组的BHT值、Vm上升率、DTABR值进行比较。结果:观察组全脑平均BHI值、Vm上升率均显著低于对照组,全脑平均DTABR值显著高于对照组,差异有统计学意义(P<0.05);观察组MoCA差值与全脑平均BHI值(r=0.265,P=0.045)、全脑平均Vm上升率(r=0.272,P=0.039)正相关,与全脑平均DTABR值负相关(r=-0.260,P=0.049);认知障碍组全脑平均BHI值、全脑平均Vm上升率显著低于正常认知组,全脑平均DTABR值显著高于正常认知组,差异有统计学意义(P<0.05);预测急性脑梗死6个月后出现认知障碍,TCD屏气试验中全脑平均BHI值的ROC曲线下面积(AUC)为0.775(95%CI:0.645~0.905,P=0.002),临界值为0.357,灵敏度为86.0%、特异度为60.0%,全脑平均Vm上升率的AUC为0.778(95%CI:0.648~0.908,P=0.001),临界值为7.451,灵敏度为83.7%、特异度为60.0%;定量脑电图全脑平均DTABR值的AUC为0.727(95%CI:0.579~0.875,P=0.009),临界值为1.133,灵敏度为66.7%、特异度为72.1%;全脑平均BHI值联合DTABR值预测脑梗死后认知障碍的AUC为0.794(95%CI:0.671~0.916,P=0.001),临界值为-0.520,灵敏度为66.7%、特异度为81.4%。结论:经颅多普勒屏气试验及定量脑电图对急性脑梗死的认知预后存在一定的评估价值,两者联合或可成为急性脑梗死后认知障碍的预测指标。Objective:Cognitive evaluation of patients with ACI was performed by TCD breath-hold test combined with QEEG to explore the application value of the two in cognitive function of acute cerebral infarction.Methods:For a prospective study,58 ACI patients in our hospital were selected as the observation group,and 45 patients who underwent physical examination during the same period were selected as the control group.TCD breath-holding test and QEEG test were performed on the two groups to obtain BHI value,Vm increase rate,DTABR value,and the two groups were evaluated by MoCA scale,and the observation group was divided into cognitive impairment group(MoCA score<26)15 cases and normal cognitive group(MoCA score≥26)43 cases,compare the two groups of BHI value,Vm increase rate,DTABR value.Results:The mean BHI value and Vm rise rate of the observation group were significantly lower than those of the control group,and the mean DTABR value of the whole brain was significantly higher than that of the control group,with statistical significance(P<0.05).The difference of MoCA in the observation group was positively correlated with the average BHI value of the whole brain(r=0.265,P=0.045),positively correlated with the average increase rate of Vm in the whole brain(r=0.272,P=0.039),and was positively correlated with the average DTABR value of the whole brain there is a negative correlation(r=-0.260,P=0.049).The average BHI value of the whole brain and the increase rate of the average Vm of the whole brain in the cognitive impairment group were significantly lower than those of the normal cognitive group,and the average DTABR value of the whole brain was significantly higher than that of the normal cognitive group,and the difference was statistically significant(P<0.05).To predict cognitive impairment 6 months after acute cerebral infarction,the area under the ROC curve(AUC)of the mean BHI value of the whole brain in the TCD breath-hold test was 0.775(95%CI:0.645~0.905,P=0.002),borderline The value was 0.357,the sensitivity wa

关 键 词：急性脑梗死 认知功能障碍 屏气试验 定量脑电图 诊断预测 

分 类 号：R742[医药卫生—神经病学与精神病学]