连续脑电监测评价重症脑血管病人预后的研究

目的探讨急性重症脑血管病患者的EEG分级与预后的关系,以及长程脑电监测评价脑功能损伤程度和预后的准确率。方法选择神经内科重症监护室中格拉斯哥昏迷评分(GCS)<8分的急性重症脑血管病患者41例,利用床边中央神经监护系统记录连续脑电图,确定急性重症脑血管病患者的EEG分级,每次行脑电监测前都进行格拉斯哥昏迷评分。结果41例重症脑血管病患者的连续脑电图全部异常,发生癫样活动的患者8例(19.5%),病死率37.5%,其中非痉挛性癫(nonconvulsive sei-zures,NCS)发生率17.1%,痉挛性癫的发生率2.4%。连续脑电图分级分成2组进行卡方检验,2组预后的差别显著;GCS评分和EEG分级与预后有关,GCS评分综合预后判断准确率78.4%,EEG分级综合预后判断准确率79.2%。结论连续脑电图分级与预后显著相关,非痉挛性癫的发生率19.5%,远高于痉挛性癫(2.4%);连续EEG动态监测和分级判断可以准确、客观地评价和预测重症脑血管疾病脑功能损伤的预后。

A study on prognostic prediction of continuous EEG monitoring in patients with critical cerebral vascular disease

Objective To observe the relationship between EEG classification and prognostic prediction in patients with critical cerebral vascular disease(CCVD),and to investigate the predictive value and accuracy of EEG's classification.Methods EEG's classification and Glasgow coma scale(GCS) were dynamically recorded at the bedside with CCVD,41 patients alone with GCS<8 were admitted.The predictability of outcome was calculated using discriminate analysis.Results The CEEG of 41 patients in critical cerebrovascular disease was nearly always markedly abnormal.The morbility of NCS was 19.5%,and that of convulsive seizures was 2.4%.There was a markedly difference between the two groups of CEEG classification and outcome by chi-square test.The prognostic accuracy of CEEG classification and GCS were 79.2% and 78.4% by logistic regression.Conclusion There is a markedly difference between the CEEG classification and outcome.The dynamic observation of EEG classification and EEG reactivity are the determinant factors for prognosis.