经颅多普勒超声和动态脑电图评估重症急性脑梗死患者短期预后的价值  

Value of transcranial Doppler sonography and ambulatory electroencephalography on evaluating short-term prognosis of patients with severe acute cerebral infarction

作　　者：雷华 曾国利[1] 朱木林[1] LEI Hua;ZENG Guoli;ZHU Mulin(Luzhou People’s Hospital,Luzhou 646000,China)

机构地区：[1]泸州市人民医院,四川泸州646000

出　　处：《中国实用神经疾病杂志》2023年第8期947-952,共6页Chinese Journal of Practical Nervous Diseases

基　　金：四川省卫生健康委员会科研课题(编号:20PJ1333)。

摘　　要：目的探究经颅多普勒超声(TCD)和动态脑电图(AEEG)评估重症急性脑梗死(ACI)患者短期预后价值。方法纳入2019-09-2021-12泸州市人民医院收治的79例重症ACI患者为研究对象,入院24 h内均完成首次床旁TCD、AEEG检查,另招募50例健康体检者为对照组。比较发病1个月后不同预后患者TCD血流参数、责任血管、侧支循环以及AEEG参数[δ波与α波比(DAR)、功率比指数(DTABR)、大脑对称指数(BSI)]、Lavizzari分级,经多因素Logistic回归分析探究预后影响因素。结果79例患者短期预后不良28例,预后良好51例。相较对照组,预后不良组、良好组大脑中动脉(MCA)收缩期流速(Vs)、舒张期流速(Vd)、平均流速(Vm)均下降(P<0.05),搏动指数(PI)均升高(P<0.05),但不同预后患者Vs、Vd、Vm、PI差异均无统计学意义(P>0.05)。预后不良组责任血管为ICA终末段占比35.71%,高于良好组的3.92%(P<0.05),存在眼动脉侧支循环占7.14%,低于良好组的33.33%(P<0.05)。相较对照组,预后不良组、良好组DAR、DTABR、BSI均升高(P<0.05),预后不良组DAR(5.47±2.68)、DTABR(3.42±1.06),高于良好组的(3.64±1.72)、(2.27±0.81),差异有统计学意义(P<0.05)。预后不良组AEEG的Lavizzari分级高于良好组(Z=4.77,P<0.05)。NIHSS评分(OR=1.874,95%CI:1.093~3.212)、责任血管为ICA终末段(OR=2.790,95%CI:1.239~6.280)、DTABR(OR=2.171,95%CI:1.187~3.970)、AEEG分级Ⅲ~Ⅴ级(OR=3.640,95%CI:1.595~8.308)均是影响重症ACI短期预后的危险因素(P<0.05),眼动脉侧支循环(OR=0.306,95%CI:0.135~1.059)则为保护因素(P<0.05)。结论经TCD评估责任血管、侧支循环以及经AEEG测量DTABR、进行脑电图分级,对重症ACI患者短期预后评估有参考价值。Objective To explore the value of transcranial Doppler sonography(TCD)and ambulatory electroencephalography(AEEG)on evaluating short-term prognosis of patients with severe acute cerebral infarction(ACI).Methods Seventy-nine patients with severe ACI admitted to Luzhou People’s Hospital between September 2019 and December 2021 were included as the study subjects.The first bedside TCD and AEEG were completed within 24 h of admission.Another 50 healthy subjects were recruited as controls.The TCD blood flow parameters,responsible vessels,collateral circulation and AEEG parameters[delta wave-to-alpha wave ratio(DAR),(delta+theta)/(alpha+beta)power ratio(DTABR),brain symmetry index(BSI)]and Lavizzari grading were compared among patients with different prognosis status after 1 month of onset.The influencing factors of prognosis were explored by multivariate Logistic regression analysis.Results Among the 79 patients,there were 28 cases of poor short-term prognosis and 51 cases of good prognosis.Compared with the control group,the systolic flow velocity(Vs),diastolic flow velocity(Vd)and mean flow velocity(Vm)of middle cerebral artery(MCA)in the poor prognosis group and the good prognosis group were decreased(P<0.05)while the pulsatility index(PI)was increased(P<0.05),but there were no significant differences in Vs,Vd,Vm and PI among patients with different prognosis status(P>0.05).The proportion of responsible vessels as ICA terminal segment of 35.71%in the poor prognosis group was higher than 3.92%in the good prognosis group(P<0.05)while the proportion of collateral circulation of ophthalmic artery of 7.14%was lower than 33.33%in the good prognosis group(P<0.05).The DAR,DTABR and BSI in the poor prognosis group and the good prognosis group were all enhanced compared to the control group(P<0.05),and the DAR and DTABR of(5.47±2.68)and(3.42±1.06)in the poor prognosis group were higher than(3.64±1.72)and(2.27±0.81)in the good prognosis group(P<0.05).The Lavizzari grading of AEEG in the poor prognosis group was higher c

关 键 词：急性脑梗死 经颅多普勒超声 动态脑电图 短期预后 

分 类 号：R743.33[医药卫生—神经病学与精神病学]