脑电趋势图监护在神经重症监护病房对癫痫及亚临床癫痫的诊断意义

Objective To explore the association between the trend of electroencephalographic (EEG) alterations and seizure (especially subclinical seizure) and assess the value of EEG trend overview obtained by continuous EEG monitoring in the diagnosis of clinical and subclinical seizures in the neurological intensive care unit (N-ICU). Methods Fifteen epileptic patients including 10 with status epileptieus (SE) in the N-ICU were enrolled in this study. The EEG was monitored using the 10-20 electrode system with 8-chaunel referential derivations (Fp1-A1, C3-A1, T3-A1, O1-A1, Fp2-A2, C4-A2, T4-A2, and O2-A2) to record the amplitude integrated EEG (aEEG), Envelope and band power (BP) trends. For each patient, the data collected during the seizure episodes and the seizure-free intervals were separately averaged for a comparative analysis. The diagnostic capabilities of the 3 EEG trends were estimated using the receiver-operating characteristic (ROC) curve. Results The total incidence of seizure in the N-ICU was 12.30% in the 15 patients, including 10 with SE (8.20%) and 7 with nonconvulsive SE (NCSE, 5.65%). In 62.5% of the patients, the SE episode was followed by NCSE. During the seizure episode, the upper and lower bounds of aEEG increased obviously by 27.9% (t=6.019, P<0.05) and 33.53% ( t=5.438, P<0.05), respectively, as compared with those in the seizure-free interval. In the seizure episodes, the wave amplitude of Envelope increased by 124.09% (t=3.229, P<0.05) in the referential derivation, and the absolute band power (ABP) increased at all the bands with significant changes in α and β band powers (t=2.528 and t=2.627, respectively, P<0.05). Conclusions Clinical and subclinical seizures occur in the N-ICU at high incidences, for which all the 3 EEG trends have diagnostic values, aEEG has a better diagnostic capability than Envelope, and the results of BP may offer references for the diagnosis.     

神经电生理监测在神经重症病房中的应用

神经电生理监测技术是目前惟一能够直接客观测量脑功能变化的工具［1］,主要包括脑电图（electroencephalogram , EEG）和诱发电位（evoked potentials ,EP）,近年来,随着神经电生理监测技术的不断进步,其在神经重症病房（neurologi‐cal intensive care unit ,NICU ）中的应用越来越广泛,地位也越来越重要,正确掌握神经电生理监测的关键技术,对于准确判断N IC U病人的脑功能损害程度,进行早期干预及改善预后有重要指导意义。本文主要介绍 EEG和 EP在 NICU中的应用,为临床工作提供参考。     

24小时脑电监护在癫痫及发作性疾病诊断中的应用

２４小时脑电监护在癫痫及发作性疾病诊断中的应用陈兴时张明岛一、基本原理脑电生理学工作者早就从Ｅｉｎｔｈｏｖｅｎ（１９０６）通过电话线路成功地传递了心电图信号得到启示，到１９７０年为止已开发脑电有线遥测和无线遥测两种［１］。近１０年来，上述研究有了进一...     

神经重症监护患者医院获得性肺炎的临床特点分析

目的：探讨神经重症监护患者治疗中,患者出现医院获得性肺炎的临床特点。方法回顾性分析2012-04-2014-04在我院接受神经重症监护的98例患者的临床资料。结果患者入院后对其痰液进行菌种培养,阳性比例不断上升,第5天全部呈现阳性,差异均具有统计学意义（ P＜0.05）;革兰阴性菌中数量最多为铜绿假单胞菌48株,革兰阳性菌中72株为金黄色葡萄球菌。结论革兰阴性菌是导致神经重症监护患者医院获得性肺炎的常见病原菌,同时患者住院期间,要格外重视由革兰阳性菌导致的医院获得性肺炎。     

假性癫痫的临床特征及视频脑电图对其诊断的价值

目的 探讨假性癫痫发作的临床特征及视频脑电图监护对其诊断的价值。方法 对15例经视频脑电图监护到发作的假性癫痫患者与15例确诊的癫痫患者的临床特征进行比较。结果 假性癫痫组,女性发病率高,发病的年龄较大,病前多有情感方面的障碍。通过在觉醒状态下发生,发作时常伴各种声音,双眼闭合,双眼睑有快速的震颤,抽搐多表现为无规律、不协调运动,无意识障碍,发作时均无痫样放电及缺氧表现。发作持续时间较长,发作后可有轻瘫。结论 视频脑电图监护可以同步观察到患者发作时的行为特征及脑电活动情况,在假性癫痫的诊断中起极其重要作用。     

60例小儿植物神经性癫痫的临床及动态脑电图监护

目的：探索脑电图监护在小儿植物神经性癫痫中的应用价值。方法：采用江苏伟思公司ＶＥＥＧ－－１１６０型脑电监护仪在安静避光的屏蔽室内进行脑电监护。结果：小儿植物神经性癫痫的ＶＥＥＧ异常率在治疗前达１００％，显著高于其普通ＥＥＧ的异常率８２％；（Ｐ＜０．０１）。治疗后其ＶＥＥＧ异常率降到４２％，仍高于ＥＥＧ的异常率３０％。结论：ＶＥＥＧ对提高小儿植物神经性癫痫的ＥＥＧ阳性率，指导临床治疗有价值     

60例小儿植物神经性癫痫的临床及动态脑电图监护

目的：探索脑电图监护在小儿植物神经性癫痫中的应用价值。方法：采用江苏伟思公司ＶＥＥＧ－１１６０型脑电监护仪在安静避光的屏蔽室内进行脑电监护。结果：小儿植物神经性癫痫的ＶＥＥＧ异常率在治疗前达１００％，显著高于其普通ＥＥＧ的异常率８２％；（Ｐ〈０．０１）。治疗后其ＶＥＥＧ异常率降到４２％，仍高于ＥＥＧ的异常率３０％。结论：ＶＥＥＧ对提高小儿植物神经性癫痫的ＥＥＧ阳性率，指导临床治疗有价值。     

脑电图监护对脑卒中后癫痫发作的诊治疗效及预后因素分析

目的探讨脑电图监护对卒中后癫痫发作的诊治及预后效果。方法纳入2013年1月至2017年11月本院重症监护病房脑卒中行脑电图(EEG)连续监测患者共568例,对纳入研究的患者进行为期1年的随访,了解脑趋势图改变与相应的癫痫发作关系,观察疗效和预后情况,对就诊、预后相关的影响因素进行Logistic回归分析。结果 568例重症监护的脑卒中后患者中89例发生了癫痫,42例保持癫痫持续状态;脑卒中后在早期出现癫痫发作的患者死亡率较高,控制脑卒中后癫痫的发作方面抗癫痫药物及镇静药物有效率达92.1%,应重视脑卒中后癫痫的早期发现和治疗。logistic回归分析发现,循环衰竭、心力衰竭、低蛋白血症、肝功能衰竭、胃肠损害、酸碱失衡及电解质紊乱、是否行无创呼吸机辅助通气与预后具有相关性。结论脑卒中继发性早期癫痫患者预后较差,预后与循环衰竭、低蛋白血症、肝功能衰竭、心力衰竭、胃肠损害、电解质紊乱、酸碱失衡有相关性,积极控制癫痫的发作,能有效改善患者的预后。     

Characteristics and clinical significance of subclinical seizures

Purpose: To define characteristics of subclinical seizures (SCS) and their prognostic significance after epilepsy surgery. Methods: Reports from intracranial video‐EEG monitoring were reviewed for patients who had epilepsy surgery between 1989 and 2003. Relationships between SCS and clinical seizures were categorized as either: complete colocalization (Group A), when both SCS and clinical seizures originated from the same single focus, or incomplete and no colocalization (Group B), when some or all SCS and clinical seizures originated from different foci in different lobes or hemispheres. Results: A total of 111 patients were included in this review. Seventy‐one (64%) patients had 2,821 SCS and most SCS came from the mesial temporal lobe. The mean duration of SCS was shorter than complex partial seizures and generalized tonic–clonic seizures but similar to simple partial seizures. SCS rarely propagated beyond the site of origin and the majority of SCS had the same area of origin as clinical seizures. Sixty‐five patients had both SCS and clinical seizures and underwent resective surgery. Group A patients had a higher seizure‐free outcome rate (77.5%) than Group B patients (37.5%). The colocalization rate of SCS and clinical seizures may impact seizure‐free outcome. The presence or absence of SCS, SCS duration, and extent of propagation of SCS did not influence surgical outcome. Conclusion: SCS commonly originate from the same cortical area as clinical seizures and are related to postsurgical outcome. These findings suggest they should be viewed as having similar significance in the surgical decision process as clinical seizures.     

Evaluation of nosocomial infection risk using APACHE II scores in the neurological intensive care unit

To evaluate the feasibility and accuracy of using the Acute Physiology, Age and Chronic Health Evaluation II (APACHE II) scoring system for predicting the risk of nosocomial infection in the neurological intensive care unit (NICU), 216 patients transferred to NICU within 24 hours of admission were retrospectively evaluated. Based on admission APACHE II scores, they were classified into three groups, with higher APACHE II scores representing higher infectious risk. The device utilization ratios and device-associated infection ratios of NICU patients were analyzed and compared with published reports on patient outcome. Statistical analysis of nosocomial infection ratios showed obvious differences between the high-risk, middle-risk and low-risk groups (p < 0.05). The area under the receiver operating characteristic curve of the APACHE II model in predicting the risk of nosocomial infection was 0.81, which proved to be reliable and consistent with the expectation. In addition, we found statistical differences in the duration of hospital stay (patient-days) and device utilization (device-days) between different risk groups (p < 0.05). Thus the APACHE II scoring system was validated in predicting the risk of nosocomial infection, duration of patient-days and device-days, and providing accurate assessment of patients’ condition, so that appropriate prevention strategies can be implemented based on admission APACHE II scores.     

颅内压监护在新生儿监护病房的应用价值

目的 研究颅内压监护在新生儿监护病房的临床应用价值.方法 新生儿监护病房共收治颅内压异常的患儿89例,进行颅内压监测,通过疾病类型、颅内压力大小和患儿死亡人数分析颅内压监测在NICU的临床应用价值.结果 89例患儿由于疾病类型的不同,颅内压不同,死亡人数也不同,且颅内压和死亡人数在不同疾病之间的差异具有统计学意义(P＜...     

神经科重症监护病房中急性脑卒中患者死亡危险因素的分析

目的 探讨神经科重症监护病房(NICU)中急性脑卒中患者死亡的危险因素.方法 归纳NICU中137例急性脑卒中患者的临床资料,对多种危险因素进行单因素及多因素Logistic回归分析.结果 单因素分析显示,年龄、昏迷、高热、肺部疾病、房颤/心脏扩大、卒中史、机械通气、脑中线移位、入院时血糖水平、急性生理与慢性健康评估(APACHE)Ⅱ评分、鼻饲管和导尿管及合并肺部感染在死亡组和生存组之间差异有统计学意义(P<0.05～0.01).多因素Logistic回归分析显示,昏迷、高热、肺部感染、机械通气以及有房颤/心脏扩大者与急性脑卒中死亡关系最为密切.结论 昏迷、高热、肺部感染、机械通气及合并房颤/心脏扩大是NICU中急性脑卒中患者死亡的重要危险因素.     

Serum levels of procalcitonin as a biomarker for differentiating between sepsis and systemic inflammatory response syndrome in the neurological intensive care unit

We explored the value of procalcitonin (PCT) to differentiate sepsis from systemic inflammatory response syndrome (SIRS), and determine sepsis severity in the neurological intensive care unit (NICU). Blood samples were measured for C-reactive protein (CRP) and PCT levels upon NICU admission, on the day of diagnosis of SIRS or sepsis, and at 3 and 7 days after diagnosis. We found that there were significant differences in serum levels of CRP and PCT as well as Glasgow Coma Scale (GCS) score upon admission between the SIRS and sepsis groups (p < 0.05). CRP and white blood cell levels were not significantly different when attempting to differentiate sepsis severity (p > 0.05). Multiple comparisons showed that significant differences in serum PCT levels were observed between sepsis and severe sepsis groups, as well as sepsis and septic shock groups (p < 0.05). We obtained the highest sensitivity and specificity for SIRS and sepsis with cut-off values of 2 ng/mL for PCT, 44 mg/dL for CRP, and 4 for the GCS. There were no differences in CRP and PCT levels between cerebrovascular disease and non-cerebrovascular disease groups (p > 0.05). No differences were found between viral and bacterial meningitis groups (p > 0.05). PCT levels are valuable in discriminating sepsis from SIRS and determining sepsis severity in critically ill patients with neurological disease.     

Continuous EEG monitoring in comatose intensive care patients

Introduction: It is unclear whether patients or subpopulations of patients might benefit from EEG monitoring. Methods: We conducted a prospective trial of continuous electroencephalogram monitoring (CEEG; 48 hours). Results: Eleven of 55 (20%) patients who underwent CEEG monitoring recorded seizures. Of patients with acute structural brain lesions (ASBLs), 10 of 31 (32%) patients experiences recorded seizures, whereas only 24 (4%) patients with metabolic encephalopathies experienced recorded seizures (p<0.01). Six patients with ASBLs (11%) and one patient with metabolic encephalopathy (4%) had spikes/interictal epileptiform discharges (p=0.087). Conclusion: Our study suggests that CEEG monitoring may be more valuable for detection of seizures in patients with ASBLs than in patients with metabolic encephalopathies.     

Quantitative neuromuscular ultrasound in the intensive care unit

Introduction: Intensive care unit acquired weakness (ICU‐AW) results from a complex mixture of nerve and muscle pathology, and early identification is challenging. This pilot study was designed to examine the ultrasonographic changes that occur in muscles during ICU hospitalization. Methods: Patients admitted to the ICU for acute respiratory failure were enrolled prospectively and underwent serial muscle ultrasound for thickness and gray‐scale assessment of the tibialis anterior, rectus femoris, abductor digiti minimi, biceps, and diaphragm muscles over 14 days. Results: Sixteen participants were enrolled. The tibialis anterior (P = 0.001) and rectus femoris (P = 0.041) had significant decreases in gray‐scale standard deviation when analyzed over 14 days. No muscles showed significant changes in thickness. Conclusions: Ultrasound is an informative technique for assessing muscles of patients in the ICU, and lower extremity muscles demonstrated increased homogeneity during ICU stays. This technique should be examined further for diagnosing and tracking those with ICU‐AW. Muscle Nerve, 2013     

The effects of infection on severe stroke patients in the neurological intensive care unit in China

Objective: To study the effects of infection on severe stroke patients in the neurological intensive care unit and to find the related risk factors for mortality of severe stroke patients.

Methods: We conducted a retrospective study including 343 patients with ischaemic or haemorrhagic stroke and staying for more than 2 patient-days in the neurological intensive care unit at Beijing Chaoyang Hospital from January 2011 to December 2015 to analyse the infection features of patients with severe stroke in the neurological intensive care unit. All analyses were conducted using SPSS 18.0.

Results: The mortality rate, hospital staying time and hospital costs between infected and uninfected stroke patients were higher in the infected patients than in the uninfected patients, P < 0.05, and except for the hospital staying time, the mortality rate and hospital costs were both significantly higher in the infected patients. Respiratory tract infection was the most common infection type at all time periods, P < 0.05. However, urinary tract infection increased at 72 h after stroke compared with infection within 72 h after stroke. Blood sugar level, mean arterial pressure, scores of APACHE II, history of stroke, history of heart diseases, infections and respiratory tract infection were significantly different in dead patients compared with the alive patients, P < 0.05.

Conclusion: Infection can significantly influence the mortality rate and hospital costs of stroke patients, and is an independent risk factor for mortality of stroke patients.