重型颅脑损伤患者TCD、神经电生理监测对预后评价的临床研究

目的 探讨经颅多普勒超声（TCD）及神经电生理监测对重型颅脑损伤患者的预后的评价。方法 回顾性分析2015年1月-2017年12月石河子大学第一附属医院神经外科重型颅脑损伤患者出院时预后良好组（格拉斯哥昏迷评分＞8分）174例，预后不良组（格拉斯哥昏迷评分≤8分）174例，采用经颅多普勒的诊断技术（TCD）、脑电图（EEG）、体感诱发电位（SEP）、运动诱发电位（MEP）和疾病资料对患者进行监测和评测。结果 348例重型脑损伤患者GCS得分为（9.34±3.25）分，预后不良组年龄≥60者占66.7%，低血压者占74.1%，瞳孔散大者占57.5%，对光反射消失者占70.7%，有心脑血管病者占70.7%，肺部感染者占55.2%、经颅多普勒检查血管重度痉挛者占32.8%，脑电图重度异常者占35.1%，体感诱发电位阳性者占58.0%，运动诱发电位阳性者占66.7%，2组患者比较差异有统计学意义（P＜0.05)。结论 经颅多普勒异常、神经电生理检测异常在一定程度上反映了重症颅脑损伤患者脑内的紊乱程度，临床评价重症颅脑损伤患者的预后，可根据患者经颅多普勒异常、神经电生理检测异常结果及疾病状况等综合进行分析，有一定的临床指导意义。

Clinical research on transcranial doppler and electrophysiological examination evaluation prognosis of severe craniocerebral injury

Objective The goal of the study was aimed to explore the prognostic factors of TCD and electrophysiological examination in patients with severe craniocerebral injury. Methods 174 good prognosis (GCS>8) and 174 poor prognosis (GCS≤8) who were hospitalized at the First Affiliated Hospital of Shihezi University between January 2015 and December 2017 were collected, and they were measured by Transcranial Doppler (TCD)， Electroencephalogram (EEG), Somatosensory Evoked Potential (SEP), and Motor Evoked Potential(MEP). Results Among the 348 severe craniocerebral injury patients, the average GCS score was 9.34±3.25. In the poor prognosis group, the group with age more than 60 accounted for 66.7%，hypotension accounted for 74.1%, pupil dilatation accounted for 57.5%, light reflex disappeared accounted for 70.7%, cardiovascular and cerebrovascular diseases accounted for 70.7%, pulmonary infection accounted for 55.2%, severe vasospasm by transcranial Doppler examination accounted for 32.8%, electroencephalogram severe abnormalities accounted for 35.1%, somatosensory evoked potential positive for 58.0%, and motor evoked potential positive for 66.7%. The difference between the two groups was statistically significant (P<0.05). Conclusion To some extent, TCD and electrophysiological examination can be used to evaluate the prognosis of patients with severe craniocerebral injury. Clinical evaluation of the prognosis of patients with severe craniocerebral injury can be based on patients with transcranial Doppler abnormalities, abnormal results of neuro-electrophysiological detection and disease status comprehensive analysis, with certain clinical significance.