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昏迷患者脑诱发电位及瞬目反射分析与预后评估

王荣辉1,张哲成2,刘娜3,朱炬2,张静4   

  1. 1. 邯郸市第一医院
    2. 天津市第三中心医院
    3. 第三中心医院神经内科
    4. 天津市第三中心医院神经内科
  • 收稿日期:2011-12-31 修回日期:2012-04-16 出版日期:2012-07-15 发布日期:2012-07-15
  • 通讯作者: 王荣辉

Analysis Of Coma Patients With Cerebral Evoked potentials And Blink Reflex And Its Prognosis Evaluation

  • Received:2011-12-31 Revised:2012-04-16 Published:2012-07-15 Online:2012-07-15
  • Contact: WANG Rong-Hui

摘要: 摘要 目的:分析昏迷患者脑诱发电位及瞬目反射特点,并结合格拉斯哥(GCS)评分探讨其对昏迷患者的预后评估价值。方法:选取我院ICU病房中GCS评分为3-12分的昏迷患者40例,于昏迷后24小时内行脑干听觉诱发电位(BAEP)、体感诱发电位(SEP)及瞬目反射(BR)检查,同时对患者进行GCS评分、脑干反射等临床评估,动态检测并观察病人预后。BAEP、SEP采用Cant分级标准分组,BR根据检查结果分组,预后分为死亡、昏迷、好转。结果:40例患者死亡23例,持续昏迷状态13例,好转4例。BAEP检查单侧或双侧Ⅲ~Ⅴ波均缺失(Cant分级Ⅲ级)者15例,14例死亡,死亡率为93%。SEP检查单侧或双侧N20均消失(Cant分级Ⅲ级)者22例,17例死亡,死亡率为77%。所有患者昏迷急性期BR均不同程度异常,其中30例完全没有反应,与预后的关系经χ2检验,差异无统计学意义(χ2=1.989,P=0.370)。BAEP、SEPCant分级均为Ⅲ级者10例,其中9例GCS评分为3分,1例GCS评分为4分,全部于1个月内死亡,死亡率100%。结论:BAEP、SEP在一定程度上能有效的预测昏迷患者的预后,二者联合可提高对昏迷患者预后的预示作用,BR在昏迷急性期有不同程度损害,尚不能准确预测预后。

关键词: 脑干听觉诱发电位, 体感诱发电位, 瞬目反射, GCS评分, 昏迷, 预后

Abstract: Abstract Objective:to analyze the cerebral evoked potentials and blink reflex characteristics of coma patients, and combined with Glasgow (GCS) score to approach its prognostic value in patients with coma. Methods: 40 score of GCS 3-12 comatose in ICU ward were examined by brainstem auditory evoked potential (BAEP)、somatosensory evoked potential(SEP) and blink reflex(BR) in 24 hours after coma,at the same time,the GCS、clinical assessment of brainstem reflex was performed,motion detection and observe the patients’ prognosis.BAEP, SEP use Cant grading standards, BR grouped according to test results, the prognosis is divided into death, persistent coma state, improved. Results: of the 40cases, 23 patients died,13 cases in persistent coma state, 4 cases improved.BAEP examination unilateral or bilateral Ⅲ ~ Ⅴwaves are missing(Cant grade Ⅲ) in 15 cases, 14 died,the mortality rate was 93%. Unilateral or bilateral SEP N20disappeared (Cant grade Ⅲ) in 22 cases, 17died, the mortality rate was 77%. BR of all patients in the acute coma state were different degrees of abnormality, of which 30 cases were no response, and prognosis was not statistically significant(χ2=1.989,P=0.370).BAEP, SEPCant grade were grade Ⅲ in 10 cases, 9 cases GCS score of 3 points, 1 case GCS score of 4 points, all died within one month, the mortality rate was100%. Conclusions:BAEP, SEP can effectively predictthe prognosis of comatose patients at certain extent,their combination can significantly improve the affect of prognosis assessment, BR in the acute state of coma were different degrees of abnormality,can not accurately predict the prognosis.

Key words: Brainstem auditory evoked potential, Somatosensory evoked potential, Blink reflex, GCS score, Coma, Prognosis