持续脑电图监测对严重脓毒症患者神经功能预后判断的价值

目的探讨持续脑电图监测对严重脓毒症患者神经功能预后判断的价值。方法对36例脓毒症患者入ICU后给予脑电图监测72h或直到转出ICU，观察其脑电图改变，并按照国际Young分级标准进行脑电图的分级随访患者3个月后的神经精神功能，按照简易精神状态检查表（MMSE）、焦虑自评量表（SAS）和抑郁自评量表（SDS）进行评估，分析预后良好组与预后不良组脑电图分级及MMSE、SAS、SDS评分之间的差异。分析脑电图分级与预后的相关性。结果36例患者中，脑电图均存在不同程度异常。脑电图Ⅰ级24例，其中17例无明显脓毒症脑病表现；Ⅱ级1例，Ⅲ级1例，Ⅳ级6例，Ⅴ级2例，Ⅵ级2例，均有不同程度的脓毒症脑病表现。36例中15例存在痫样放电，预后均较差，其中9例为非惊厥癫痫（NCS）或非惊厥癫痫持续状态（NCSE）占25.00%，6例为惊厥性癫痫（GCS）或惊厥性癫痫持续状态（GCSE）占16.70%。脑电图分级越高，预后不良率越高。脑电图分级与预后呈正相关。结论严重脓毒症患者均存在不同程度的脑电图异常，是否存在SAE与其严重度有关，且NCS或NCSE发生率较高，预后较差；脑电图分级与预后呈正相关，可以作为评估严重脓毒症患者脓毒症相关性脑功能障碍及神经功能预后的标准。

Continuous electroencephalographic monitoring in evaluating prognosis of neural function in patients with severe sepsis

Objective To assess the early continuous electroencephalography(EEG) monitoring in evaluation of prognosis of neural function in patients with severe sepsis. Methods Thirty six patients with sepsis admitted in ICU underwent continuous EEG monitoring for 72h or until discharged from ICU. The neuropsychological function of patients was followed up according to the international Young''s classification after 3 months; the simple Mental State checklist (MMSE), Self-rating Anxiety Scale(SAS) and Self-rating Depression Scale(SDS) were applied for evaluation. The correlation between EEG finding and neural function was analyzed. Results There were 24 cases with EEG class I, among whom 17 cases had no septic encephalopathy. There were 1 case with EEG class II, 1 case with class III, 6 cases with level IV and 2 cases class V and 2 cases with class VI, all these 12 patients had different degrees of septic encephalopathy. Among 36 cases, 15 had epileptic discharge with poor prognosis, including 9 cases of non-convulsive seizures(NCS) or non-convulsive status epilepticus(NCSE) (25.00%), 6 cases of eclampsia epilepsy (GCS) or convulsion status epilepticus (GCSE)(16.70%). EEG classification was positively correlated with prognosis; the higher EEG classes, the poorer prognosis of patients. Conclusion Patients with severe sepsis have varying degrees of EEG abnormalities, and EEG classification may be used for evaluation of neural functional prognosis in septic patients.