脑损害昏迷患者意识/昏迷深度的无创监测及量化研究

目的探索通过脑状态监测仪（cerebral state monitor，CSM）获取患者数字化处理的脑电（EEG）信号：脑电指数（脑状态指数cerebral state index，CSI）、肌电指数（eleetromyographic，EMG）、爆发抑制指数（bunt suppression，BS），量化昏迷深度及脑功能损害程度。方法对50例临床脑损害昏迷患者进行CSM监测，分析这些指标与患者的体征反射、听觉诱发电位（AEP）、格拉斯哥昏迷评分（GCS）及格拉斯哥预后评分（GOS）改变的关系。结果CSl0—100是从清醒到深昏迷、脑死亡的一个连续不断的刻度范围，与患者昏迷深度确切相关，与GCS昏迷评分、体征反射相应消涨；特别在恒定刺激作用下的CSI变化，结合BS、EMG能够准确判断患者预后，量化脑功能的改变并赋予其相应的临床意义。结论通过CSM无创实时监测获得量化的、数字化的脑功能损害程度，可以建立起量化的、数字化的脑功能损害临床标准，客观地指导临床救治和把握预后。

Quantitative study and undamage monitor of consciousness depth/ coma degree in unconscious patients with brain harm

Objective To evaluate the measure of coma/consciousness depth and damage degree in brain function by CSI, BS and EMG. Methods The CSI, BS, EMG, AAI and symptom, reflect, GCS were simultaneously adopted on 50 patients with severe brain harm. Each monitoring parameter was scored and the relationship between the scores and GCS, GOS was synthetically established. Results The CSM quantifies direct the coma/consciousness depth and damage degree of brain function in a succession scale range 0-100 from brain death, depth coma, to awake. The findings of CSI (BS, EMG, AAI, and D/ FR, BSR, Breath Type et al) were significantly associated with GCS and GOS, and very valuable in estimate of severity and prediction of outcome for patients with severe brain harm, especially combined BS, EMG at invariablenes ache stimulation. The patients with CSI 40-80 were in the situation of shallow coma to addicted sleep (GCS 6-8); CSI 10-40 companioned BS and rising CSI stimulated in the medium coma (GCS 4-5); CSI 0-10 companioned over BS 75 and rising CSI followed stimulation but swift falling in the deep coma (GCS 3) and worse prognosis; CSI continue 0, BS 100 and stimulating unchanged in the brain death. Conclusions The quantifiable digit of coma/consciousness depth and damage degree in brain function by CSM can strike up a clinical digit standard of cerebral harm and objectively guide clinic therapy and grasp prognosis, these will improve the actuality of scoring for coma/consciousness depth and prognosis in artificial diversity and lack evidence.