神经电生理监测在重型颅脑损伤患者生存预后相关因素中的应用-《中国医学物理学杂志》

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Title:: Use of neuroelectrophysiological monitoring technology to analyze prognostic factors related with survival in patients with severe traumatic brain injury

文章编号:: 1005-202X（2023）09-1151-05

作者:: 陈钫; 谢薇; 魏攀; 刘兴智; 李天贵; 曾梦非; 肖明; 江春; 赵柏皓; 陈虹林; 成都市龙泉驿区第一人民医院（四川大学华西医院龙泉医院）神经外科，四川成都 610100

Author(s):: CHEN Fang; XIE Wei; WEI Pan; LIU Xingzhi; LI Tiangui; ZENG Mengfei; XIAO Ming; JIANG Chun; ZHAO Baihao; CHEN Honglin; Department of Neurosurgery, the First Peoples Hospital of Longquanyi District (Longquan Hospital, West China Hospital, Sichuan University), Chengdu 610100, China

关键词:: 神经电生理监测; 重症颅脑损伤; 预后; 脑电图; 体感诱发电位; 运动诱发电位

Keywords:: Keywords: neuroelectrophysiological monitoring severe traumatic brain injury prognosis electroencephalogram somatosensory evoked potential motor evoked potential

分类号:: R35；R651.1

DOI:: DOI:10.3969/j.issn.1005-202X.2023.09.015

文献标志码:: A

摘要:: 目的：探讨神经电生理监测技术在重症颅脑损伤（STBI）患者预后恢复中的应用价值及其相关性。方法：采取病例对照回顾性研究方法，92例STBI患者纳入本次研究，根据治疗后患者的预后结局将其分为良好组57例、不良组35例，对比两组患者入院后48 h内的神经电生理监测结果，采用受试者工作曲线（ROC）分析脑电图（EEG）、体感诱发电位、运动诱发电位在预测患者预后中的价值，采用Logistic回归模型分析神经电生理监测结果与STBI患者预后的关系。结果：预后不良组患者EEG中重度异常患者占比74.29%、体感诱发电位阳性患者占比71.43%、运动诱发电位阳性患者占比71.43%，预后良好组患者EEG中重度异常患者占比24.56%、体感诱发电位阳性患者占比33.33%、运动诱发电位阳性患者占比35.09%，差异均有统计学意义（P<0.05）；Logistic回归模型分析，显示：瞳孔散大、对光反射消失、GCS评分<6分、休克、脑疝、EEG中重度异常、体感诱发电位阳性、运动诱发电位阳性是STBI患者不良预后结局的独立危险因素（P<0.05）；EEG预测患者不良预后结局的灵敏度为74.29%、特异度为75.44%、ROC曲线下面积AUC值为0.759；体感诱发电位预测患者不良预后结局的灵敏度为71.43%、特异度为66.67%、ROC曲线下面积AUC值为0.690；运动诱发电位预测患者不良预后结局的灵敏度为71.43%、特异度为64.91%、ROC曲线下面积AUC值为0.682。结论：EEG中重度异常、体感诱发电位阳性、运动诱发电位阳性与STBI患者预后恢复不佳关系密切，且EEG预测患者预后恢复不良具有一定的临床价值。

Abstract:: Abstract: Objective To explore the role of neuroelectrophysiological monitoring in predicting the prognosis in patients with severe traumatic brain injury (STBI), and to discuss the correlation. Methods A retrospective case-control study of 92 STBI patients was conducted. According to prognostic outcome, the patients were divided into good prognosis group (n=57) and poor prognosis group (n=35). The neuroelectrophysiological monitoring results of the two groups within 48 h after admission were compared. The value of electroencephalogram (EEG), somatosensory evoked potential and motor evoked potential in predicting STBI prognosis was analyzed using receiver operating characteristic (ROC) curve. The relationship between the results of neuroelectrophysiological monitoring and STBI prognosis was analyzed by Logistic regression model. Results The patients with moderate and severe EEG abnormalities, positive somatosensory evoked potential, and positive motor evoked potential accounted for 74.29%, 71.43%, and 71.43% in poor prognosis group, significantly different from 24.56%, 33.33%, and 35.09% in good prognosis group (P<0.05). Logistic regression model analysis showed that dilated pupils, loss of light reflex, GCS score<6, shock, cerebral hernia, moderate and severe EEG abnormalities, positive somatosensory evoked potential and positive motor evoked potential were independent risk factors for poor prognosis in STBI patients (P<0.05). The sensitivity, specificity and AUC of EEG in predicting poor prognosis were 74.29%, 75.44% and 0.759, respectively and those of somatosensory evoked potential were 71.43%, 66.67% and 0.690, respectively and those of motor evoked potential were 71.43%, 64.91% and 0.682, respectively. Conclusion Moderate and severe EEG abnormalities, positive somatosensory evoked potential and positive motor evoked potential are closely related to the poor prognosis in STBI patients, and EEG has certain clinical value in predicting poor prognosis.

《中国医学物理学杂志》[ISSN:1005-202X/CN:44-1351/R]

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