量化脑电图在成人非超急性期缺血缺氧性脑病预后评估中的作用  

The value of qEEG in evaluating outcome of adult hypoxic ischemic encephalopathy beyond the super-acute phase

作　　者：陆志荣 冯慧宇[1] 陈玲[1] 倪冠中[1] 冯黎[1] LU Zhirong;FENG Huiyu;CHEN Ling;NI Guanzhong;FENG Li(Department of Neurology,The First Affiliated Hospital,Sun Yat-sen University,Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases,National Key Clinical Department and Key Discipline of Neurology,No.58 Zhongshan Road 2,Guangzhou,510080,China)

机构地区：[1]中山大学附属第一医院神经科,广东省重大神经疾病诊治研究重点实验室,国家临床重点专科和国家重点学科,广州510080 [2]南宁市第六人民医院神经内科

出　　处：《中国神经精神疾病杂志》2022年第10期582-589,共8页Chinese Journal of Nervous and Mental Diseases

基　　金：广东省重大神经疾病诊治研究重点实验(编号:2020B1212060017);广东省神经系统疾病临床医学研究中心(编号:2020B1111170002);华南神经疾病早期干预及功能修复研究国际联合研究中心(编号:2015B050501003、2020A0505020004);广东省神经系统重大疾病诊治工程技术研究中心;广东省神经系统重大疾病诊治转化医学创新平台和广州市神经系统重大疾病临床医学研究与转化中心(编号:201604020010)项目;岭南神经病学中青年医生临床研究专项支持项目(编号:2021067)。

摘　　要：目的探讨量化脑电图在成人非超急性期(起病超过72 h)缺血缺氧性脑病患者临床预后评估中的价值。方法前瞻性纳入2019年9月至2022年4月中山大学第一附属医院神经科ICU收治的非超急性期成人缺血缺氧性脑病患者,行量化脑电图检查,根据起病180 d后格拉斯哥预后评分(Glasgow outcome scale,GOS)将患者分为苏醒组和未苏醒组,比较分析两组患者量化脑电图中振幅整合脑电图、相对频带能量、相对α变异性及光谱熵,并分析上述指标与患者预后的关系。结果共纳入22例成人缺血缺氧性脑病患者,苏醒组6例,未苏醒组16例。两组缺血缺氧时间、进行颅脑影像学检查和进行量化脑电检查时间无统计学差异。22例患者均行量化脑电图监测。苏醒组患者振幅整合脑电图5例均为正常连续背景(分级为Ⅰ级),1例为Ⅱ级;未苏醒组患者振幅整合脑电图重度异常有13例(分级为Ⅲ级)、轻度异常2例(Ⅱ级),P=0.001;苏醒组患者相对频带能量提示4例以δ波为主,未苏醒组患者相对频带能量提示脑电波均以δ波为主,苏醒组和未苏醒组α/δ值(alpha/delta ratio,ADR)比较有统计学差异[0.19(0.07,0.35)vs.0.14(0.11,0.17),P<0.0001];苏醒组与未苏醒组相对ɑ变异分值比较有统计学差异[4(3.5,4)分vs.1.75(1,3)分,P<0.0001];苏醒组与未苏醒组光谱熵值比较有统计学差异[(56.76±3.79)vs.(45.13±1.83),P<0.001]。两组患者量化脑电图振幅整合脑电图趋势、ADR值、相对ɑ变异性分值及频谱熵均有统计学差异(P<0.05),且振幅整合脑电图趋势、相对ɑ变异性分值及频谱熵与患者起病180 d GOS评分具有统计学相关性(P<0.05)。结论量化脑电图或可在一定程度反映缺血缺氧后脑损伤程度,对判断起病72 h后成人缺血缺氧性脑病患者的预后或具有一定临床应用价值。Objective To investigate the prognostic value of quantitative EEG(qEEG)in evaluating the outcome of adult hypoxic ischemic encephalopathy(HIE)beyond the super-acute phase(72 h after onset).Methods The patients with HIE beyond 72 h admitted to the NICU of FAH-SYSU from September 2019 to August 2022 were prospectively enrolled.Subjects were divided into Group Awake and Group Unawake according to score of Glasgow outcome scale(GOS)after 180 days since onset.The clinical data and results of qEEG test were collected and analyzed.Results Twenty-two cases were enrolled.Among them,6 were divided into the Group Awake and 16 were into the Group Unawake.The sex ratio,age,time of taking imaging and timing of qEEG test were not significantly different between the two groups.All 6 patients in the Group Awake presented with amplitude-integrated EEG(aEEG)with consecutive normal background,while Group Unawake presented with severe abnormality in 13 cases and with mode rate abnormality in 2 cases,P=0.001.Theα/δratio(ADR)was in Group Awake was significantly different with that in Group Unawake[0.19(0.07,0.35)vs.0.14(0.11,0.17),P<0.001].The difference of relativeα-variability(RAV)between Group Awake and presented was significantly different[4(3.5,4)vs.1.75(1,3),P<0.0001].Additionally,the spectrum entropy(SE)was significantly different between Group Awake and Group Unawake[56.76±3.79 vs.45.13±1.83,P<0.001].The grade of qEEG,ADR,RAV and SE were significantly different between the two groups.The grade of qEEG,RAV and SE were correlated with GOS of patient at 180 d since onset.Conclusion qEEG may facilitate the evaluation of prognosis of adult patients with HIE beyond the super-acute phase.

关 键 词：量化脑电图 缺血缺氧性脑病 振幅整合脑电图 相对α变异性 ADR值 频谱熵 预后评估 成人 

分 类 号：R741.044[医药卫生—神经病学与精神病学]