神经电生理检查及脑血流评价对重症脑血管病脑功能监测及预后的影响

目的评价诱发电位、持续脑电图监测、经颅多普勒对重症脑血管病患者脑功能监测及预后的影响。方法收集住神经加强病房（N．ICU）的重症脑血管病患者32例,根据GCS评分,分为重症组（GCS≤8分）和非重症组（GCS〉8分）两组,入院后应用海神肌电图仪监测脑干听觉诱发电位、体感诱发电位并根据CANT分为Ⅰ、Ⅱ、Ⅲ三级,分别比较重症组与非重组脑干听觉诱发电位、体感诱发电位的表现,并比较不同级别脑干听觉诱发电位、体感诱发电位与预后的关系;应用太阳科技有限责任公司Solar2000多功能监护仪,进行床旁持续脑电图监护,采用Young的脑电图分级标准进行脑电图分级,比较重症组、非重症组脑电图表现,并比较不同级别脑电图与预后的关系;采用Nicolet-EMETC-2002-Ⅲ型经颅多普勒仪,选用2MHz脉冲多普勒探头,通过颞窗或眼窗测定脑动脉血流速度,并根据血流速度分为：（1）血流速度增高组;（2）血流速度减低组;（3）血流速度正常组。并比较血流速度与患者病情轻重及预后的关系。结果（1）重症组病死率为42．86％,明显高于非重症组的死亡率22．22％,而非重症组,其良好率为33、33％,好转率为44．44％,均明显好于重症组。（2）重症组体感诱发电位、脑干听觉诱发电位表现为Ⅲ级者,明显高于非重症组（P〈0、05）,其病死率高,预后不良,而体感诱发电位、脑干听觉诱发电位表现为Ⅰ级者,预后相对较好。（3）32例脑血管患者进行持续脑电图监测,结果发现多数表现为YoungⅠ、Ⅱ级,Ⅱ级者病死率（63．64％）明显比Ⅰ级（14．29％）高,而脑电图Ⅰ级者预后相对较好。（4）经颅多普勒表现为血流速度增高、血流速度减低或血流速度正常者与其病情轻重、预后的关系尚不能确定,P〉0．05。结论持续床旁监测脑干听觉诱发电位、体感诱发电位、脑电图可准确、客观地评价重症脑血管病患者脑功能,并能预测预后,指导治疗,血流速度与重症脑血管病病情轻、重,以及与预后的关系有待进一步研究。

The cerebral function monitoring in severe cerebral vascular disease

OBJECTIVE: To evaluate the value of combined evoked potential, continuous EEG with transcranial Doppler to monitor the cases of severe cerebral vascular disease. METHODS: 32 cases of severe cerebral vascular disease were admitted to the hospital and divided into severe or moderate groups based on the GCS (< or = or > 8) when the patients were admitted. BAEP and SEP were used to for monitoring of brain and brainstem functions. The BAEP and SEP results were divided into grade I, grade II and grade III according to Cant's classification. Continuous EEG monitored all patients by bedside. The EEG findings were divided into 6 grades based on Young's criteria. TCD monitoring by using bilateral 2 MHz Probes with probe holder were lasted at least 30 minutes per day through temporal windows and eye windows to explore the velocity of cerebral artery. The patients were classified into three groups according to the velocities, i.e. (1) the group with elevated velocity, (2) the group with reduced velocity, and (3) the group with normal velocity. The association among the brain and brain stem function, cortex function and cerebral flow velocity was analyzed with patient outcome in the two groups. RESULTS: (1) The mortality of the patients in the severe group was 42.86%, significantly higher than that in the group of moderate symptom (22.22%). The survivors with good outcome accounted for 33.33% in the moderate group, and those with independent disability accounted for 44.44% in the moderate group, much better than those in the severe group. (2) The numbers of the patients with III grade SEP and BAEP results in the severe group were higher than those in the moderate group. The mortality of the patients with III grade SEP and BAEP results was high and the most of survivors were found with obvious disability in outcome. The patients with grade I SEP and BAEP results showed a better outcome. (3) 32 patients of cerebral vascular disease were monitored with continuous EEG monitoring by bedside. The results revealed that the mortality of the patients with grade II EEG results was much higher than that of the patients with grade I EEG results. (4) The association of the brain blood flow velocity, either increased or decreased or within normal range was uncertain (all P > 0.05). CONCLUSION: The cerebral function of patients of severe cerebral vascular disease may be estimated precisely and objectively by using continuous monitoring of SEP, BAEP and EEG at bedside, which will provide valuable information about patient's prognosis and treatment.