原发性脑干出血患者的神经电生理特征研究  

Neuro-electrophysiological characteristics of patients with primary brainstem hemorrhage

作　　者：周良 王健 陈鑫[1] 刘劲芳[1] Zhou Liang;Wang Jian;Chen Xin;Liu Jinfang(Department of Neurosurgery,Xiangya Hospital of Central South University,Changsha 410008,China)

机构地区：[1]中南大学湘雅医院神经外科,长沙410008

出　　处：《中华外科杂志》2025年第3期219-226,共8页Chinese Journal of Surgery

摘　　要：目的探讨原发性脑干出血(PBSH)患者的神经电生理特征。方法本研究为回顾性病例系列研究。回顾性分析2022年1月至2023年12月中南大学湘雅医院神经外科收治的17例格拉斯哥昏迷量表评分3~8分的PBSH患者的临床资料。男性14例,女性3例,年龄[M(IQR)]46.0(14.0)岁(范围:18.0~70.0岁)。患者均在发病后28 d内行神经电生理监测。根据发病后6个月格拉斯哥预后量表(GOS)评分,将PBSH患者分为意识未恢复组(GOS评分1~2分,13例)和意识恢复组(GOS评分3~5分,4例)。记录患者短潜伏期体感诱发电位(SLSEP)成分N20、脑干听觉诱发电位(BAEP)、脑电图背景活动、脑电反应性(EEG-R)、脑电图睡眠结构、电极Fz处N1的波幅绝对值(FzN1A)、电极Cz处N1的波幅绝对值(CzN1A)、电极Fz处MMN的波幅绝对值(FzMMNA)、电极Cz处MMN的波幅绝对值(CzMMNA)。通过Fisher确切概率法和Mann-Whitney U检验分析两组各神经电生理指标的差异。结果17例PBSH患者脑电图背景活动以α模式、α-θ模式及θ模式为主。α模式患者4例,其中意识恢复3例(均存在EEG-R);α-θ模式患者3例;θ模式患者5例,其中死亡2例。脑电图背景活动为δ模式的患者5例,预后较差,其中死亡4例,存活但未恢复意识1例。SLSEP成分N20双侧消失12例,BAEP双侧消失5例。FzN1A、CzN1A未引出者均为4例,FzMMNA、CzMMNA未引出者均为6例。两组患者BAEP、脑电图背景活动、EEG-R、FzN1A、CzN1A、FzMMNA及CzMMNA的差异均有统计学意义(P值均<0.05);N20及脑电图睡眠结构无差异(P值均>0.05)。结论BAEP、脑电图背景活动、EEG-R、FzN1A、CzN1A、FzMMNA及CzMMNA等神经电生理指标可能与PBSH患者6个月能否恢复意识相关,临床实践中建议结合多项指标进行综合分析。Objective To investigate the neuro-electrophysiological characteristics of patients with primary brain stem hemorrhage(PBSH).MethodsThis is a retrospective case series study.The clinical data of 17 PBSH patients with Glasgow coma score 3 to 8 points who were admitted to the Department of Neurosurgery,Xiangya Hospital of Central South University from January 2022 to December 2023 were retrospectively analyzed.There were 14 males and 3 females,with an age(M(IQR))of 46.0(14.0)years(range:18.0 to 70.0 years).All patients underwent electro-physiological monitoring within 28 days after the onset of the disease.According to Glasgow outcome scale(GOS)6 months after onset,PBSH patients were divided into two groups:unregained consciousness group with(GOS 1 to 2 points,13 cases)and regained consciousness group(GOS 3 to 5 points,4 cases).The neuro-electrophysiological indicators involved in this study included short latency somosensory evoked potential(SLSEP)component N20,brainstem auditory evoked potential(BAEP),electroencephalogram(EEG)background activity,EEG reactivity(EEG-R),EEG sleep structure waves,absolute amplitude of N1 at electrode Fz(FzN1A)and Cz(CzN1A),respectively,absolute amplitude of mismatch negativity at electrode Fz(FzMMNA)and Cz(CzMMNA),respectively.Then,the Fisher exact probability test and Mann Whitney U test were used for counting data and measurement data,respectively,to analyze the differences of neuro-electrophysiological indicators between the two groups.ResultsThe EEG background activity of 17 PBSH patients was mainlyα-mode,α-θmode andθmode.Four patients withα-mode,3 of whom regained consciousness(all with EEG-R).There were 3 patients withα-θpattern.And 5 patients withθpattern,2 of whom died.Five patients with background EEG activity of delta pattern had poor prognosis,of which 4 patients died and 1 patient survived but did not regain consciousness 6 months after onset.SLSEP component N20 were absent bilaterally in 12 cases and BAEP in 5 cases.FzN1A and CzN1A were not extracted in 4 cases,a

关 键 词：脑干 脑出血 原发性脑干出血 昏迷 脑电图 脑电反应性 脑干听觉诱发电位 失匹配负波 

分 类 号：R743.34[医药卫生—神经病学与精神病学]