中潜伏期体感诱发电位预测重症脑卒中患者预后的应用价值

目的 探讨中潜伏期体感诱发电位(middle-latency somatosensory evoked potentials,MLSEP)预测急性重症脑卒中患者预后的应用价值.方法 对70例症状出现7 d内的重症脑卒中患者行格拉斯哥昏迷评分(Glasgow Coma Scale,GCS)、短潜伏期体感诱发电位(short-latency somatosensory evoked potentials,SLSEP)和MLSEP检测,6个月后采用改良Rankin评分和生存与死亡两个预后标准进行预后评估.健康对照组20名行SLSEP和MLSEP检测.统计学分析MLSEP、SLSEP和GSC与预后的一致性及预测的准确性.结果 健康对照组均记录到双侧N20、N35和N60,脑卒中组患者MLSEP波形有缺失,而且病灶侧MLSEP各波消失比例明显高于对侧.双侧N60消失与预后不良(Kappa=0.828,P＜0.01)和死亡(Kappa=0.686,P＜0.01)的一致性均最好.预测准确性分析显示:病灶侧N60消失预测不良预后和死亡的敏感性高达100%,较病灶侧N20消失的敏感性(85.7%)提高了14.3%;双侧N60消失预测预后不良的特异性为100%,与双侧N20消失一致;但预测死亡的特异性为82.9%,不如双侧N20消失(97.1%).结论 MLSEP可反映脑损伤程度,预测预后不良的敏感性高于SLSEP,建议将MLSEP和SLSEP联合用于重症脑损伤后的评估与预后的预测.

Abstract：

Objective To explore the effectiveness of using middle-latency somatosensory evoked potentials (MLSEP) to predict the prognosis in patients with acute severe stroke. Methods MLSEP, shortlatency somatosensory evoked potentials (SLSEP), and Glasgow Coma Scale (GCS) were recorded in 70 acute severe supratentorial stroke patients within 1 week after onset. All patients were evaluated with modified Rankin Scale (mRS) and follow-up in 6 months after onset. SLSEP and MLSEP were recorded in 20 normal controls. The consistency between MLSEP, SLSEP, GCS and prognosis, as well as the prognostic authenticity of MLSEP, SLSEP, and GCS were analyzed. Results Bilateral N20, N35, and N60 exited in all normal controls. Some waves of MLSEP were absent in stroke patients, and the proportion of absent waves in ipsilateral MLSEP was higher than in contralateral MLSEP. The consistency between bilateral absence of N60 and unfavorable outcome ( Kappa = 0.828, P ＜ 0.01 ), and between bilateral absence of N60 and death ( Kappa = 0.686, P ＜ 0.01 ) was satisfactory. By using the prognostic authenticity analysis of predictors, the ipsilateral absence of N60 showed the highest sensitivity ( 100% ) for unfavorable outcome and death, which added 14.3% compared with the sensitivity of ipsilateral absence of N20 ( 85.7% ). Bilateral absence of N60 showed a high specificity of 100% for unfavorable outcome, which equaled bilateral absence of N20.However, it showed a lower specificity ( 82.9% ) for death, than bilateral absence of N20 (97.1% ).Conclusions MLSEP was able to reflect the degree of brain injury and showed higher sensitivity than SLSEP for predicting unfavorable outcomes. Therefore combined use of MLSEP and SLSEP in evaluating and predicting the outcomes in brain injuries is suggested.

Evaluate using of middle-latency somatosensory evoked potentials in predicting outcomes of patients with severe stroke

Objective To explore the effectiveness of using middle-latency somatosensory evoked potentials (MLSEP) to predict the prognosis in patients with acute severe stroke. Methods MLSEP, shortlatency somatosensory evoked potentials (SLSEP), and Glasgow Coma Scale (GCS) were recorded in 70 acute severe supratentorial stroke patients within 1 week after onset. All patients were evaluated with modified Rankin Scale (mRS) and follow-up in 6 months after onset. SLSEP and MLSEP were recorded in 20 normal controls. The consistency between MLSEP, SLSEP, GCS and prognosis, as well as the prognostic authenticity of MLSEP, SLSEP, and GCS were analyzed. Results Bilateral N20, N35, and N60 exited in all normal controls. Some waves of MLSEP were absent in stroke patients, and the proportion of absent waves in ipsilateral MLSEP was higher than in contralateral MLSEP. The consistency between bilateral absence of N60 and unfavorable outcome ( Kappa = 0.828, P ＜ 0.01 ), and between bilateral absence of N60 and death ( Kappa = 0.686, P ＜ 0.01 ) was satisfactory. By using the prognostic authenticity analysis of predictors, the ipsilateral absence of N60 showed the highest sensitivity ( 100% ) for unfavorable outcome and death, which added 14.3% compared with the sensitivity of ipsilateral absence of N20 ( 85.7% ). Bilateral absence of N60 showed a high specificity of 100% for unfavorable outcome, which equaled bilateral absence of N20.However, it showed a lower specificity ( 82.9% ) for death, than bilateral absence of N20 (97.1% ).Conclusions MLSEP was able to reflect the degree of brain injury and showed higher sensitivity than SLSEP for predicting unfavorable outcomes. Therefore combined use of MLSEP and SLSEP in evaluating and predicting the outcomes in brain injuries is suggested.