脑电图对大脑半球大面积脑梗死患者早期神经功能预后的预测价值研究  

The predictive value of EEG on early neurological prognosis of patients with large hemispheric infarction

作　　者：刘刚[1] 田飞[1] 陈卫碧[1] 范琳琳[1] 崔黎黎 宿英英[1] 张艳[1] Liu Gang;Tian Fei;Chen Weibi;Fan Linlin;Cui Lili;Su Yingying;Zhang Yan(Department of Neurology,Xuanwu Hospital,Capital Medical University,Beijing 10053,China)

机构地区：[1]首都医科大学宣武医院神经内科,北京100053

出　　处：《北京医学》2023年第5期379-383,共5页Beijing Medical Journal

基　　金：国家自然科学基金(81671037)。

摘　　要：目的探讨EEG对大脑半球大面积脑梗死(large hemispheric infarction,LHI)患者早期神经功能预后的预测价值。方法选取2018年1月至2022年6月首都医科大学宣武医院神经内科的LHI患者68例。根据患者发病后6个月改良Rankin量表(modified Rankin scale,mRS)评分分为预后良好组和预后不良组,所有患者在卒中发病48~72 h内接受床旁EEG监测。比较两组患者9种EEG分级的差异,采用ROC曲线评估EEG对LHI患者早期神经功能的预后预测价值。结果68例患者中,男31例,女37例,年龄28~80岁,平均(60.9±10.9)岁。预后良好20例,占29.41%。与预后良好组相比,预后不良组的α优势(有反应性)、慢波增多(有反应性)较低(8.3%比45.0%,6.3%比40.0%),差异有统计学差异(P<0.05)。EEG分级预测LHI患者预后的ROC曲线的AUC为0.854(95%CI:0.764~0.943,P<0.01),其中α优势(有反应性)、慢波增多(有反应性)、α或θ昏迷和爆发抑制的灵敏度均>90%,但α优势(有反应性)和慢波增多(有反应性)特异性较差,分别为55%和60%。结论EEG分级能够客观反映LHI患者脑损伤的严重程度,有助于LHI患者早期神经功能预后的预测。Objective To explore the predictive value of EEG on early neurological prognosis of patients with large hemispheric infarction(LHI).Methods A total of 68 patients with LHI in the Department of Neurology,Xuanwu Hospital,Capital Medical University from January 2018 to June 2022 were selected,and were divided into good prognosis group and poor prognosis group according to the score of modified Rankin scale(mRS)six months after the onset.All patients received bedside EEG monitoring within 48~72 h after stroke onset.The differences of nine patterns of EEG between the two groups were compared,and the predictive value of EEG for early neurological function in patients with LHI was evaluated by ROC curve.Results Among the 68 patients,there were 31 males and 37 females,aged from 28 to 80 years,with an average of(60.9±10.9)years.The prognosis was good in 20 cases,accounting for 29.4%.Compared with the good prognosis group,theαadvantage(reactivity)and slow wave increase(reactivity)in the poor prognosis group were lower(8.3%vs.45.0%,6.3%vs.40.0%),and the difference was statistically significant(P<0.05).The AUC of the ROC curve for predicting the prognosis of patients with LHI by EEG grading was 0.854(95%CI:0.764~0.943,P<0.01),in which the sensitivity ofαdominance(reactivity),slow wave increase(reactivity),α/θcoma and burst inhibition were all over 90%,but the specificity ofαdominance(reactivity)and slow wave increase(reactivity)was poor,which were 55%and 60%respectively.Conclusions EEG grading can objectively reflect the severity of brain injury in patients with LHI,which is helpful to predict the early prognosis of neurological function in patients with LHI.

关 键 词：脑电图 大脑半球大面积脑梗死 神经功能 预后 预测 

分 类 号：R743.33[医药卫生—神经病学与精神病学]