脑电图反应性分级联合脑干听觉诱发电位对重型颅脑损伤患者的预后评估作用

刘稀金 张海艳 陈勇军 张平 刘贵香 李欣

[摘要] 目的 探讨脑电图反应性分级联合脑干诱发电位对重型颅脑损伤患者的预后评估作用。 方法 选取本院重症监护病房的100例重型颅脑损伤昏迷患者，进行视频脑电监测及脑干听觉诱发电位监测，根据脑电图反应性分级与患者预后进行分析，并进行预后准确率比较。 结果 患者脑电图反应性分级与预后密切相关，分级越高，预后越差（χ2=61.575，P=0.043，P<0.05）;单独应用视频脑电图对预后评价的敏感性和特异性偏低，通过视频脑电图反应性分级联合脑干听觉诱发电位，能显著提高患者预后评估的准确性（χ2=6.814，P=0.039，P<0.05）。 结论 脑电图反应性分级与脑干听觉诱发电位相结合，在重型颅脑损伤患者预后评估中具有重要意义，值得在临床推广。

[关键词] 重型颅脑损伤;脑电图反应性分级;脑干听觉诱发电位;昏迷;预后评估

[中图分类号] R714          [文献标识码] B          [文章编号] 1673-9701（2021）24-0038-03

EEG reactivity grading combined with brainstem auditory evoked potentials on prognostic assessment of patients with severe craniocerebral injury

LIU Xijin   ZHANG Haiyan   CHEN Yongjun   ZHANG Ping   LIU Guixiang   LI Xin

Department of Neurology，Nanhua Hospital Affiliated to University of South China，Hengyang   421000，China

[Abstract] Objective To investigate the prognostic assessment effect of electroencephalogram （EEG） reactivity grading combined with brainstem evoked potentials in patients with severe craniocerebral injury. Methods A total of 100 patients with severe craniocerebral injury hospitalized in the intensive care unit of our hospital from September 2017 to May 2020 were selected.Video EEG monitoring followed by brainstem auditory evoked potential monitoring was performed on each patient. The prognosis was analyzed according to the EEG reactivity grade and the prognosis， and the prognosis accuracy was compared. Results The patient′s EEG reactivity grading was closely related to the prognosis，the higher the grade，the worse the prognosis （χ2=61.575，P=0.043，P<0.05）.EEG monitoring alone had low sensitivity and specificity for patients′ prognostic assessment，and the combination of EEG reactivity grading and brainstem auditory evoked potential monitoring significantly improved the accuracy of prognostic assessment（χ2=6.814，P=0.039，P<0.05）. Conclusion The combination of EEG reactivity grading and brainstem auditory evoked potentials has excellent significance for the prognostic assessment of patients with craniocerebral injury，which is worthy of promotion in clinical practice.

[Key words] Severe craniocerebral injury; Electroencephalogram reactivity grading; Brainstem auditory evoked potentials; Coma; Prognostic assessment

重型颅脑损伤（Severe brain injury，SBI）患者是临床上的危重症，随着我国老年化进程加快，自发性脑出血、工伤、车祸等疾病发病率日益上升，重型颅脑损伤患者数量较之前明显增加。虽然目前医学水平总体较之前提高，患者死亡率下降，但患者长期的昏迷状态，给医生的病情判断造成困扰。因此，如何对昏迷患者预后進行有效评估，具有重要临床及社会意义。本研究就脑电图反应性分级联合脑干诱发电位对重型颅脑损伤的预后评估作用进行探讨，现报道如下。