急性脑梗塞定量脑电图频谱分析

对３３例急性脑梗塞患者和２０例年龄匹配的健康老年人进行定量脑电图频谱分析发现，健康人各脑区的主频均数在９Ｈｚ以上，以ａ２频段为主，病例组各脑区的主频均数多数在８Ｈｚ以下，以θ、δ频段为主；急性脑梗塞病灶侧θ、δ频段相对功率值显著增高，同健测及对照相比较，差异有显著性意义。提示主频分布及各频段相对功率值可作为评价脑功能的稳定指标。     

脑死亡病人的脑电图监测

目的 探讨脑死亡的临床特征及脑电图在脑死亡诊断中的作用。方法 对32例符合脑死亡临床标准的患进行脑电图监测。结果 在32例符合脑死亡临床标准的患中，27例在脑死亡12h后脑电图监测已呈静息电位。其余5例在脑死亡72h后脑电图监测也呈静息电位。结论 当患符合脑死亡临床标准，脑电图监测呈静息电位时，方可作出脑死亡的诊断。     

脑电图在评估脑死亡中的应用

目的评价脑电图(EEG)在判定脑死亡中的作用。方法选择浙江省各大医院临床诊断为脑死亡患者88例。其中男性54例,女性34例,年龄16～82岁,平均(43．6±18．5)岁。采用意大利EB Neuro公司Belight便携式脑电图仪,按国际10／20标准,用针电极进行描记,对88例临床诊断脑死亡患者相隔12 h行2次EEG检测。结果以脑电静息,即不出现>2μV的脑波活动作为脑死亡的EEG诊断标准。88例中有81例(92．04％)患者在相隔12 h行2次EEG检查,其结果均呈脑电静息表现。其中6例(6．82％)患者EEG检查存在低幅脑波活动。另1例(1．14％)首次EEG检查干扰太大影响结果判断,间隔12 h检查即显示脑电静息。结论EEG用于评估脑死亡具有较高的敏感性,在严格控制仪器参数及检测条件和动态观察的情况下,可将其作为判断脑死亡的一项重要辅助检查手段。     

经颅多普勒对脑死亡患者脑血流动力学的观察

脑死亡概念是现代临床医学进步的象征。本研究采用经颅多普勒（TCD）技术观察8例脑死亡患者的脑血流频谱，探讨脑死亡的脑血流动力学动态变化规律，对TCD诊断脑死亡研究作一些补充。     

潜在脑死亡后器官捐献供者脑死亡判定中脑电与脑血流"分离现象"的相关因素分析

目的明确脑死亡判定确认检查中脑电与脑血流"分离现象"的影响因素,加强对该现象的了解及认知。方法前瞻性收集中山大学附属第一医院神经外科及重症医学科自2018年6月至2019年5月收治的127例潜在脑死亡后器官捐献(DBD)供者的相关临床资料。所有患者首选脑电和脑血流评估作为脑死亡判定的确认检查方式,对存在"分离现象"的患者,进一步行正中神经短潜伏期诱发电位检查或等待24 h再次进行脑电和脑血流评估以确诊。选择性别、年龄、进行确认检查时自主呼吸停止时间、血压、手术方式、神经查体、神经影像学指标和血Na+等15个参数,通过单因素和多因素Logistic回归分析,明确与"分离现象"相关的危险因素。结果127例患者中,22例(17.3%)存在"分离现象",其中17例(77.2%)脑电静息早于脑血流终止,5例(22.7%)脑血流终止早于脑电静息。多因素Logstic分析结果显示,患者年龄≤14岁(OR=6.250,95%CI:1.201~32.220,P=0.028)、检查时收缩压≥140 mmHg(OR=7.430,95%CI:1.621~33.992,P=0.010)、原发性脑干损伤(OR=15.890,95%CI:3.042~82.930,P=0.006)、自主呼吸停止时间≤72 h(OR=11.964,95%CI:3.045~82.932,P=0.006)及去骨瓣减压术(单侧/双侧)(OR=16.281,95%CI:1.590~89.785,P=0.001)是"分离现象"的独立危险因素。结论"分离现象"在中国脑死亡判定的确认检查中常见,≤14岁患者、检查时收缩压≥140 mmHg、原发性脑干损伤、自主呼吸停止时间≤72 h和行去骨瓣减压手术(单侧/双侧)患者更易出现"分离现象"。     

脑死亡脑电非线性定量分析

目的:运用近似熵(ApEn)和C0复杂度对脑死亡患者脑电图(EEG)进行非线性定量分析,期望寻找一种可靠而又敏感的脑死亡诊断标准。方法:研究对象35例,其中男性21例,女性14例;年龄16～85岁。根据其临床表现和EEG结果分为脑死亡组、临床脑死亡组和非脑死亡组。对每组进行ApEn和C0复杂度分析,并比较3组结果。结果:脑死亡组患者17例,男性11例,女性6例;年龄21～82岁。临床脑死亡组5例,男性3例,女性2例;年龄16～85岁。非脑死亡组13例,男性7例,女性6例;年龄17～84岁。脑死亡组的ApEn值约为1.0,非脑死亡组的ApEn值约为0.3,临床脑死亡组ApEn值介于两者之间。脑死亡组C0复杂度值约为0.17,非脑死亡组C0复杂度值约为0.06,临床脑死亡组介于两者之间。无论是ApEn还是C0复杂度,数值上越接近脑死亡组者预后越差,反之越好。讨论:ApEn和C0复杂度对EEG进行非线性定量分析都是判定脑死亡较好的辅助检查。     

有机磷中毒患者的脑电图分析

我院2001年7月-2003年7月收治16例有机磷中毒患，现将其脑电图表现报告如下。     

精神分裂症患者的脑电图分析

为了探讨精神分裂症患者脑电图表现，对此进行研究。     

精神分裂症患者的脑电图改变

本文通过２１３例精神分裂症患者脑电图分析，发现脑电图异常率为２２．１％；脑电图异常绝大多数为轻度异常（占异常总数９５．７％），主要表现为θ波增多，少数患者θ波弥散出现。脑电图正常者，不规则脑电图明显高于正常人，表现为β波增多，有少数α脑电图者可出现α波慢化趋势和泛化现象。脑电图异常率最高为青春型，最低为偏执型。男、女患者脑电图异常无显著差异。此外通过精神分裂症与神经症患者脑电图比较，发现他们脑电图异常改变相近似，因而进一步证实了精神分裂症患者脑电图改变无特异性。     

植物状态患者脑电反应性量化分析

目的探讨脑电反应性量化分析在植物状态患者预后判别中的价值。方法采用目测及计算机量化分析判别痛觉刺激前、后植物状态患者的脑电图反应性,与患者意识恢复进行相关性分析,进而比较两种分析方法的敏感性、特异性及准确性。结果 28例患者中,11例意识恢复,17例未恢复。目测组有反应性11例,其中7例意识恢复;量化分析组有反应性10例,9例意识恢复。两组均与患者意识恢复有相关性,P值均<0.05。脑电图EEG反应性量化分析组对植物状态患者意识恢复判断的敏感性为94.12%、特异性为81.82%、准确性为89.29%、均高于目测观察组(76.47%,63.64%,71.43%)。结论脑电反应性计算机量化分析可准确预测植物状态患者的意识恢复能力,可作为临床评估植物状态患者意识恢复能力的有效方法。     

EEG changes under hyperbaric conditions: spectral analysis during simulated diving

Continuing investigations of the influences of the hyperbaric pressure upon EEG record in divers during simulated diving. The hyperbaric ecological system exerts influences on brain bioelectric activity manifesting itself by changes of alpha frequency and appearance of slow waves. The changes in the brain activity are mostly observable at the changes in chamber pressure values. The changes in EEG recordings are smallest at constant pressures. EEG examination can be used as a measure of the safety of newly developed decompression schedules.     

Continuous EEG monitoring in patients with traumatic brain injury reveals a high incidence of epileptiform activity

BACKGROUND: EEG is the only available method for real time monitoring of the brain and is therefore of great interest in the neurointensive care. The present study describes our experiences from implying continuous EEG monitoring as a routine method. We also present EEG patterns observed on patients with traumatic brain injury (TBI). METHODS: Seventy TBI patients requiring neurointensive care were included. Digital EEG was recorded continuously. Five minutes every hour were analysed off-line. RESULTS: Twenty-three patients (33%) developed seizures, 74+/-47 h after trauma. The seizures were brief, responding to phenytoin, or persistent, requiring propofol or barbiturate sedation. Six out of eight patients with persistent seizures had intracerebral contusions. Eighteen patients (26%) displayed focal high frequency activity that proceeded to seizures in eight cases. Twelve patients (17%) developed recurrent paroxysmal delta activity. The patients in the seizure group were significantly older (62+/-12 vs. 28+/-17 years) and more often exposed to low energy trauma (87% vs 22%) compared to the paroxysmal delta pattern group. CONCLUSION: TBI implies high risk for development of epileptiform activity, with a time lag between trauma and seizure onset. TBI patients also displayed other EEG pattern that should be investigated further in order to obtain a better understanding of posttraumatic mechanisms.     

Computerized EEG analysis in migraine patients

Computerized analysis and topographical mapping were performed on the EEGs of 28 migraine patients (17 without and 11 with typical aura) and an age and sex-matched control group of 28 subjects.Traditional visual EEG analysis revealed only a slight diffuse slowing of theta band in eight patients (28.6%), and computerized analysis revealed significant changes in eleven (39.3%). The most frequently altered parameters were an increase in the relative power of the slow bands and/or a decrease in that of alpha band. These variations appeared to be particularly significant in the posterior regions. No significant inter-hemisphere asymmetry was revealed. Comparisons between the patient and control groups showed that the only statistically significant difference was a bilateral increase in theta power in the parieto-occipital regions of the patients.We conclude that the role of topographical EEG mapping in the clinical diagnosis of migraine is still limited.

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Sommario L'analisi computerizzata ed il mappaggio topografico dell'EEG sono stati eseguiti in 28 pazienti affetti da emicrania (17 con emicrania senz'aura e 11 con emicrania con aura tipica) e in 28 soggetti di controllo corrispondenti per età e sesso.L'analisi visiva tradizionale dell'EEG evidenziava unicamente dei modesti rallentamenti diffusi di banda theta in 8 pazienti (28.6%).L'analisi computerizzata mostrava alterazioni significative in 11 pazienti (39.3%): i parametri più frequentemente alterati consistevano in un aumento della potenza relativa della banda alpha. Tali variazioni apparivano particolarmente significative sulle regioni posteriori. Non si evidenziavano significative asimmetrie interemisferiche. Il confronto tra il gruppo dei pazienti e i controlli mostrava come unica differenza statisticamente significativa un aumento della potenza della banda theta nei soggetti emicranici sulle regioni parieto-occipitali bilateralmente.Si conclude per un ruolo tuttora limitato del mappaggio topografico dell'EEG nella diagnosi clinica di emicrania.

     

Role of EEG in the diagnosis of brain death

Brain death diagnosis is based upon several clinical and paraclinical criteria that have been legally defined. There is a medico-legal protocol when brain death diagnosis is made in order to allow organ removal for a possible transplantation. In France, EEG or cerebral arteriography must legally be used to confirm a clinical brain death suspicion. There is a specific procedure to perform an EEG to confirm the diagnosis of brain death. However all the criteria have been made using conventional paper EEG, while numerized is now used. The comparison of EEG recording using both analogical and numerised acquisition allow us to report several recommendations to use EEG for brain death diagnosis.     

脑电图反应性联合中脑形态对重型颅脑损伤昏迷患者预后评估的临床研究

目的 探讨脑电图(EEG)反应性联合中脑形态对重型颅脑损伤昏迷患者临床预后的评估价值. 方法 选择南方医科大学附属花都医院神经外科自2011年4月至2012年10月收治的116例重型颅脑损伤昏迷患者,入院后72h内选用数字化视频EEG监测系统对患者行EEG监测,同时行头颅CT扫描并测量中脑前后径与横径的比值.统计分析患者EEG反应性、中脑前后径与横径的比值与患者预后的关系. 结果 116例患者中EEG有反应65例,无反应51例;中脑前后径与横径的比值为0.9～1.1者60例,比值＞1.1或＜0.9者56例.EEG有反应组预后良好率高于EEG无反应组,中脑前后径与横径的比值为0.9～1.1组预后良好率高于比值＞1.1或＜0.9组,差异有统计学意义(P＜ 0.05);EEG反应性联合中脑形态评估重型颅脑损伤昏迷患者预后的敏感度、特异度均较高. 结论 EEG反应性联合中脑形态检测可有效评估重型颅脑损伤昏迷患者的预后.     

Facial myokymia in brain death

BACKGROUND: Brain death (BD) is the irreversible loss of all functions of the brain and brainstem. Spontaneous and reflex movements of the limbs have been described in this condition. However, facial myokymia (FM) in BD has not been previously reported. The origin of that motor phenomenon in alive patients is still uncertain, since supranuclear, nuclear and peripheral mechanisms have been proposed. OBJECTIVE: We describe the presence of FM in a patient who fulfilled the criteria for BD. A 40-year-old-man had right-sided weakness and impaired consciousness. After 14 h admission, he fulfilled the criteria for BD. A CT scan of the head showed a large putaminal hemorrhage. The EEG was isoelectric. At that time, fine spontaneous twitches of the left cheek were noticed. They consisted of repetitive and rhythmic movements in groups of 3-5 lasting for < 5 s. These movements appeared every 2-10 min during 6 h. DISCUSSION: Spinal reflexes have been described in BD. The presence of any movements other than the recognized reflexes may question this diagnosis and limit organ procurement for transplantation. The recognition of FM as an accepted movement in BD patients has practical and legal implications.     

300例癫痫及可疑癫痫患者AEEG分析

目的：对３００例癫痫及可疑癫痫患者的动态脑电图的应用价值进行了初步探讨。方法;使用北京明思公司ＳＷ－ＪＨ系列智能化脑电监护仪描记,并与常规脑电图比较。结果：３００例中ＥＥＧ异常５４例,ＡＥＥＧ异常１７８例ＡＥＥＧ痫样放电检出率明显高天ＥＥＧ。１４４例继发性癫痫患者中,ＥＥＧ异常８例,ＡＥＥＧ异常１０例,二者无显著性差异。     

颅脑外伤患者继发医院颅内感染的病原学分析及脑电图监测

目的探讨颅脑外伤患者继发医院颅内感染的病原学因素,总结脑电图监测意义,以期降低感染率,控制病情进展。方法回顾性分析2009—2013年1 031例颅脑外伤患者,对其中59例颅内感染者从病原菌分布、细菌耐药等方面进行总结,观察脑电图的临床价值。结果59例感染中分离出病原菌71株,其中革兰阴性菌占59.15%,革兰阳性菌占35.21%,真菌占5.64%;主要以铜绿假单胞菌、大肠埃希菌、金黄色葡萄球菌、肺炎克雷伯菌等为主;在耐药性上,革兰阴性菌中耐药性较低的抗菌药物有利奈唑胺、亚胺培南,余抗生素耐药性均在11.76%以上。而在革兰阳性菌中耐药性较低的抗生素为替考拉宁、万古霉素,余均在16.67%以上。脑电图上,治疗2周后颅内感染检出率为55.66%。结论颅脑外伤继发医院颅内感染以革兰阴性菌为主,脑电图有助于防治感染。     

脑电图、经颅多普勒超声、体感诱发电位检测对昏迷患者脑功能评判的价值

目的探讨脑电图(EEG)、经颅多普勒超声(TCD)、体感诱发电位(SEP)检测对昏迷患者脑功能评判的价值。方法采用EEG、TCD、SEP3种检测方法,对72例昏迷患者(浅昏迷12例,中度昏迷17例,睁眼昏迷4例,深昏迷39例)进行检测脑功能并评分。结果首次检测EEG25例呈电静息、TCD28例无血流信号、SEP26例P14皮质电位消失,均在深昏迷组。复查EEG时17例最终为电静息;另有24例TCD具有振荡波、钉子波频谱改变。脑功能评分:EEGV级42例、Ⅳ级10例、Ⅲ级14例;TCDV级28例、Ⅳ级9例、Ⅲ级6例、Ⅱ级9例;SEPⅢ级27例。死亡28例及多种原因放弃治疗的25例患者以深昏迷组为多。结论昏迷程度越深,EEG、TCD、SEP分级越高,预后越差;EEG、TCD、SEP检测对评价昏迷患者脑功能状态、预测预后提供了客观、可靠的依据。