脑出血预后危险因素及事件相关电位在意识监测中的应用
Prognostic factors of postoperative patients with intracerebral hemorrhage and application of event-related potentials in consciousness monitoring
何蒙蒙 1褚晨 1高建瓴2
作者信息
- 1. 苏州大学附属第四医院重症医学科(苏州 215000)
- 2. 苏州大学附属第四医院重症医学科(苏州 215000);苏州大学附属第一医院重症医学科
- 折叠
摘要
目的 探讨脑出血术后患者6个月不良预后的危险因素,并研究事件相关电位(event-related potential,ERP)对预后的诊断效能.方法 前瞻性纳入40例脑出血术后患者作为研究对象,收集患者年龄、性别、术前出血量、入院时格拉斯哥昏迷评分(Glasgow coma scale,GCS)等资料.所有研究对象应用ERP进行术后第1、3、7、14天失匹配负波(mismatch negativity,MMN)的测量,并同步进行改良昏迷恢复量表(coma recovery scale-revised,CRS-R)的评估.6个月后电话随访患者格拉斯哥预后评分(Glasgow outcome scale,GOS),1～2分定义为预后差,3～5分定义为预后良好.采用多因素Logistic回归分析影响患者结局预后的危险因素,探究MMN波幅变化值与CRS-R变化值的相关性,并采用ROC曲线评估MMN对患者预后的预测价值.结果 预后良好患者术前出血量、入院GCS评分、术后第3、7、14天的MMN波幅与预后差的患者比较差异有统计学意义;多因素Logistic回归分析显示,术后第14天的MMN波幅是预后差的独立危险因素(OR=0.100,95%CI:0.000～0.355,P<0.05).MMN波幅与CRS-R呈强相关,相关系数为0.643(P<0.01).术后第14天的MMN波幅对6个月的临床预后具有较高的诊断效能.结论 术后第14天的MMN波幅越低提示患者预后越差,ERP对患者意识障碍的监测有望成为预测脑出血术后患者预后的有效工具.
Abstract
Objective To explore the risk factors of prognosis of patients with intracerebral hemorrhage at 6 months after operation,and to study the diagnostic efficacy of event-related potential(ERP)on outcome and prognosis.Methods Forty postoperative patients with intracerebral hemorrhage were prospectively enrolled.The age,sex,preoperative blood loss and GCS were collected.The mismatch negative wave(MMN)was measured by ERP on the 1st,3rd,7th and 14th day after operation,and the modified coma recovery scale(CRS-R)was evaluated simultaneously.The Glasgow outcome scale(GOS)of patients was assessed by telephone follow-up after 6 months GOS 1～2 and 3～5 was defined as poor prognosis and good prognosis.,respectively.Multivariate Logistic regression analysis was used to analyze the risk factors affecting the outcome and prognosis of patients,to explore the correlation between MMN and CRS-R,and ROC curve was used to evaluate the predictive value of MMN on the prognosis of patients.Results There were significant differences in the preoperative blood loss,admission GCS score and MMN amplitude between patients with good prognosis and those with poor prognosis on the 3rd,7th and 14th day after operation.Multivariate Logistic regression analysis showed that MMN amplitude on the 14th day after operation was an independent risk factor for poor prognosis(OR=0.100,95%CI:0.000～0.355,P<0.05).The amplitude of MMN was strongly correlated with CRS-R and the correlation coefficient was 0.643(P<0.01).The amplitude of MMN on the 14th day after operation had a high diagnostic efficiency for the clinical prognosis at 6 months.Conclusion The lower the amplitude of MMN on the 14th day after operation,the worse the prognosis of patients.ERP monitoring of postoperative disturbance of consciousness in patients with intracerebral hemorrhage is expected to become an effective tool to predict the prognosis of patients.
关键词
脑出血术后/失匹配负波/危险因素/意识/ROC曲线Key words
Postoperative cerebral hemorrhage/Mismatch negativity(MMN)/Risk factors/Consciousness/ROC curve引用本文复制引用
出版年
2024
NETL
NSTL
万方数据