查看更多>>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.
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