恢复期体感诱发电位对严重意识障碍儿童预后的预测价值  

Functional and prognostic assessment of children with severe disorders of consciousness using convalescent somatosensory evoked potentials

作　　者：冯英[1] 段晓玲[1] 林莉[1] 陶亮 张明强 黄秋怡 肖农[1] Feng Ying;Duan Xiaoling;Lin Li;Tao Liang;Zhang Mingqiang;Huang Qiuyi;Xiao Nong(Department of Rehabilitation Children′s Hospital of Chongqing Medical University,National Clinical Research Center for Child Health and Disorders,Ministry of Education Key Laboratory of Child Development and Disorders,Chongqing Key Laboratory of Pediatrics,Chongqing 400014,China)

机构地区：[1]重庆医科大学附属儿童医院康复科,国家儿童健康与疾病临床医学研究中心,儿童发育疾病研究教育部重点实验室,儿科学重庆市重点实验室,重庆400014

出　　处：《中华物理医学与康复杂志》2023年第11期986-991,共6页Chinese Journal of Physical Medicine and Rehabilitation

基　　金：重庆市科卫联合医学科研项目(2021MSXM229)。

摘　　要：目的探讨恢复期体感诱发电位(SEP)对多种获得性脑损伤(创伤、感染、缺氧等)所致的严重意识障碍儿童预后的预测价值。方法选取2013年7月至2021年12月在重庆医科大学附属儿童医院首次接受康复治疗,并完成SEP检查的286例严重意识障碍儿童,从电子病历中获取患儿的一般资料及SEP检查结果,按病因将其分为创伤性脑损伤组(103例)、颅内感染组(101例)、缺氧缺血性脑损伤组(42例)、其它病因组(40例)。通过随访获取患儿的意识状态及功能恢复情况,采用格拉斯哥结局量表(GOS)评估其病程1年时的功能结局,开展回顾性分析。结果随访时间最长至病程8年,随访期间死亡16人,其中1年内死亡4人。随访时病程满1年的患儿共191例,其中创伤性脑损伤67例、颅内感染63例、缺氧缺血性脑损伤30例、其它病因31例。病因分别为创伤性脑损伤、颅内感染、缺氧缺血性脑损伤时,双侧N20存在的患儿,其病程1年时的功能结局良好率高于单/双侧N20缺失的患儿(P<0.05)。对于创伤性脑损伤组,双侧N20存在对于良好结局的预测有一定作用,特异性为90.9%,敏感性为55.6%,阳性预测值为92.6%,阴性预测值为50%,阳性似然比为6.111。单/双侧N20消失不能准确预测不良预后。对于颅内感染组,双侧N20存在对于良好结局预测的特异性低,但单/双侧N20消失预测不良结局有一定作用,特异性为82.4%,敏感性为62.1%,阳性预测值为75%,阳性似然比为3.517。对于缺氧缺血性脑损伤组,双侧N20存在不能准确预测良好预后,而单/双侧N20消失预示不良预后,特异性87.5%,敏感性72.7%,阳性预测值94.1%,阳性似然比5.818。结论恢复期SEP对严重意识障碍儿童的预后有一定的预测价值。病因为创伤性脑损伤时,双侧N20存在可以作为预后良好的指标;病因为颅内感染或缺氧缺血性脑损伤时,N20消失提示预后不良。Objective To explore the value of convalescent somatosensory evoked potentials(SEPs)in formulating a prognosis for children with severe disorders of consciousness(DOC)caused by brain trauma,infection or hypoxia.Methods This was a retrospective cohort study of 286 children with DOC children treated between 2013 and 2021.They were divided into a trauma group(n=103),an intracranial infection group(n=101),a hypoxia group(n=42)and an other-causes group(n=40).Their consciousness status and functional recovery were obtained in follow-up appointments,and their functional condition 1 year after discharge was assessed using the modified Glasgow Outcome scale(GOS).Results During 8-year follow-up,16 had died,with 4 deaths within 1 year.Among the 191 cases followed up to 1 year,children with a bilateral N20 SEP had significantly better functional outcomes than those with unilateral or bilateral N20 absence.For the trauma group,the presence of a bilateral N20 signal was a strong indicator of good functional outcome at the 1-year follow-up,with a specificity of 90.9%,sensitivity of 55.6%,positive predictive value(PPV)of 92.6%,negative predictive value(NPV)of 50%and a positive likelihood rate(PLR)of 6.111.However,for the intracranial infection group,the presence of N20 had a low specificity for predicting good outcomes,though the absence of an N20 potential predicted poor functional outcome at 1 year with a specificity of 82.4%,sensitivity of 62.1%,PPV of 75%,and PLR of 3.517.For the hypoxic group,bilateral N20 could not predict a good prognosis,though its absence meant a poor outcome,with a specificity of 87.5%,sensitivity of 63.6%,PPV of 93.3%,and PLR of 5.818.Conclusion SEPs during the recovery period can help to formulate a prognosis for children with severe DOC.Traumatic brain injury and the presence of bilateral N20 potentials can be used as a good prognostic indicator.For intracranial infection and hypoxic-ischemic brain injury,the absence of an N20 potential indicates a poor prognosis.

关 键 词：体感诱发电位 意识障碍 儿童 预后预测 

分 类 号：R748[医药卫生—神经病学与精神病学]