活动描记法对神经外科重症监护室患者睡眠监测的价值  

Value of actigraphy on sleep monitoring for patient in neurosurgical intensive care unit

作　　者：刘爽 范学武 田龙[1] LIU Shuang;FAN Xue-wu;TIAN Long(Department of Neurosurgical Intensive Care Unit,the First Affiliated Hospital of Hebei Northern University,Zhangjiakou 075000,China)

机构地区：[1]河北北方学院附属第一医院神经外科重症监护室,张家口075000 [2]河北省人民医院导管室

出　　处：《临床神经病学杂志》2022年第5期359-365,共7页Journal of Clinical Neurology

基　　金：张家口市重点研发计划项目(1921002B)。

摘　　要：目的以多导睡眠描记法(PSG)作为金标准,评价基于腕带式监测仪的活动描记法(ACTG)对神经外科重症监护室(NICU)患者清醒和睡眠相监测结果以及替代PSG法的可能性。方法采用ACTG法和PSG法对46例筛选入组的NICU患者进行睡眠监测,其中机械通气患者14例,非机械通气患者32例。分别记录两种方法获取的患者同一时刻起清醒平静至中度镇静状态时间间隔(清醒相时长)和中度镇静至清醒平静状态时间间隔(睡眠相时长),并进行统计学分析。之后,以PSG法作为金标准,计算ACTG法对睡眠相判断的敏感度和特异性。结果ACTG法与PSG法清醒相相关系数为0.721(P=0.037),睡眠相为0.642(P=0.009);机械通气患者中清醒相为0.598(P=0.022),睡眠相为0.531(P=0.028);非机械通气患者中清醒相为0.832(P=0.006),睡眠相为0.784(P=0.019)。ACTG法与PSG法监测结果的一致性较好,特别在非机械通气患者中。ACTG法对患者睡眠监测的敏感度和特异性分别为0.739和0.783,其中机械通气患者的敏感度和特异性分别为0.593和0.685,非机械通气患者为0.750和0.875。结论ACTG法与PSG法较好的相关性和一致性证明其用于NICU患者睡眠监测是可行的,临床工作中可以用ACTG法替代PSG法,尤其是非机械通气的患者。Objective Taking polysomnography(PSG)as the gold standard,to evaluate the awake and sleeping phase monitoring result for patient in neurosurgical intensive care unit(NICU)based on wrist band monitor(ACTG)and the possibility of replacing PSG.Methods Sleep of forty-six NICU patients who met inclusion-exclusion criteria was monitored by ACTG and PSG method,including fourteen mechanically ventilated patients and thirty-two non-mechanically ventilated patients.The time interval from awake calm to moderate sedation from the same time(awake phase duration)and the time interval from moderate sedation to awake calm(sleeping phase duration)obtained by the two methods respectively was recorded and statistically analyzed.Then,taking PSG as the gold standard,the sensitivity and specificity of ACTG for judging sleeping phase was calculated.Results The correlation coefficient between ACTG and PSG was 0.721(P=0.037)for awake phase duration and 0.642(P=0.009)for sleeping phase duration.The correlation coefficient was 0.598(P=0.022)for awake phase duration and 0.531(P=0.028)for sleeping phase duration in mechanically ventilated patients.The correlation coefficient was 0.832(P=0.006)for awake phase duration and 0.784(P=0.019)for sleeping phase in non-mechanically ventilated patients.The consistency of the two methods was excellent,especially in the non-mechanically ventilated patients.The sensitivity and specificity of ACTG was 0.739 and 0.783,respectively.While in mechanically ventilated patients,the sensitivity and specificity were 0.593 and 0.685.And in non-mechanically ventilated patients,they were 0.750 and 0.875.Conclusions The excellent correlation and consistency between ACTG and PSG proved that it was feasible to use ACTG for awake and sleeping phase monitoring in NICU patients.It could replace PSG,especially for non-mechanically ventilated patients.

关 键 词：神经外科重症监护室 多导睡眠描记法 活动描记法 睡眠监测 

分 类 号：R740[医药卫生—神经病学与精神病学]