体感诱发电位联合改良昏迷恢复量表对儿童重症脑损伤恢复期意识障碍的预后评价  

Prognostic value of somatosensory evoked potentials combined with coma recovery scale-revised in children with disorder of consciousness in convalescence of severe brain injury

作　　者：刘华[1] 谭亚琼[1] 胡继红[1] 何金华[1] 段雅琴 潘英 LIU Hua;TAN Yaqiong;HU Jihong;HE Jinhua;DUAN Yaqin;PAN Ying(Hunan Children’s Hospital,Changsha 410007,China)

机构地区：[1]湖南省儿童医院,湖南长沙410007

出　　处：《中国实用神经疾病杂志》2023年第1期67-71,共5页Chinese Journal of Practical Nervous Diseases

基　　金：湖南省卫生健康委科研课题(编号:202106041218);湖南省残疾人康复科研项目(编号:2021XK0308);湖南省临床医疗技术创新引导项目(编号:2020SK50512)。

摘　　要：目的探讨体感诱发电位(SEP)、改良昏迷恢复量表(CRS-R)及其联合指标对重症脑损伤恢复期意识障碍患儿的预后评价作用。方法选取51例重症脑损伤恢复期意识障碍患儿为研究对象,所有患儿均在入康复中心时完成SEP检查和CRS-R评分,并动态追踪评估患儿意识水平变化,以病程满6个月、神志转清或死亡为评估止点。以患儿病程满6个月时意识恢复作为预后判断金标准,根据病程6个月内患儿意识恢复与否分为意识清醒组和意识未清醒组,分别分析SEP分级、CRS-R评分与意识障碍患儿预后之间的相关性,并采用ROC曲线评估SEP分级、CRS-R评分及其联合指标对意识障碍患儿预后的预测作用。结果CRS-R评分与意识障碍患儿预后呈正相关(r=0.450,P<0.01),SEP分级与意识障碍患儿预后呈负相关(r=—0.340,P<0.05)。CRS-R评分的ROC曲线下面积(AUC)为0.761,SEP分级的AUC为0.683,SEP分级联合CRS-R评分的AUC为0.809,且SEP分级联合CRS-R评分的AUC大于SEP分级单一指标的AUC,差异有统计学意义(Z=2.054,P<0.05)。结论SEP分级和CRS-R评分均可作为重症脑损伤恢复期意识障碍患儿的预后判断指标,且SEP分级联合CRS-R评分的预测价值高于单一SEP分级的预测价值。Objective To investigate the prognostic value of somatosensory evoked potentials(SEP),co⁃ma recovery scale-revised(CRS-R)and their combined indexes in children with disorder of consciousness in con⁃valescence of severe brain injury.Methods A total of 51 cases of children with disorder of consciousness in con⁃valescence of severe brain injury were included in the study.All the children completed CRS-R and SEP examina⁃tion after admitted to the rehabilitation center,the changes in the level of consciousness of the children were dy⁃namically tracked and evaluated,and the assessment endpoint was course of disease for half a year,consciousness recovery or death.The recovery of consciousness at the end of half a year course of the disease was used as the gold standard for prognostic judgment.The children were divided into conscious group and unconscious group according to the recovery of consciousness within half a year.The correlation between SEP grade,CRS-R score and the prognosis of children with disorders of consciousness was analyzed.The ROC curve was used to evaluate the predictive value of SEP grade,CRS-R score and their combined indexes on the prognosis of children with disor⁃ders of consciousness.Results CRS-R score is positively correlated with the prognosis of children with disorders of consciousness(r=0.450,P<0.01).SEP grade was negatively correlated with the prognosis of children with disor⁃ders of consciousness(r=—0.340,P<0.05).The areas under the ROC curve(AUC)of CRS-R score was 0.761,AUC of SEP grade was 0.683,and the AUC of SEP grade combined with CRS-R score was 0.809.The AUC of SEP grade combined with CRS-R score was larger than that of the single SEP grade index,and the difference was statistically significant(Z=2.054,P<0.05).Conclusion SEP grade and CRS-R score can be used as prognostic indexes for children with disorder of consciousness in convalescence of severe brain injury,and the predictive value of SEP grade combined with CRS-R score is higher than that of single SEP grade.

关 键 词：重症脑损伤 恢复期 意识障碍 改良昏迷恢复量表 体感诱发电位 预后 儿童 

分 类 号：R748[医药卫生—神经病学与精神病学]