脑电双频指数和振幅整合脑电图在昏迷儿童近期预后中的评价
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摘要
目的研究脑电双频指数(BIS)和振幅整合脑电图(aEEG)在昏迷儿童近期预后评价中的应用价值。方法选择2016年6月至2018年3月儿科重症监护病房(PICU)收治的昏迷儿童60例,均伴不同程度的脑损伤,入院后接受BIS监测与床旁aEEG记录。3个月后分别采用时间分辨免疫荧光法、放射免疫法测定血清β内啡肽(β-EP)、神经元特异性烯醇化酶(NSE)水平及记录儿童脑功能等级评分(PCPC)评估近期预后情况。结果随着BIS平均值的降低,aEEG异常程度加重,患儿血清β-EP、NSE水平逐渐升高(P<0.01);Pearson相关性分析显示BIS平均值与血清β-EP、NSE水平负相关,aEEG异常程度与血清β-EP、NSE水平正相关(P<0.05)。随着BIS平均值的降低,aEEG异常程度更严重,患儿PCPC评分分级逐渐升高(P<0.05);Pearson相关性分析显示BIS平均值与PCPC评分分级负相关,aEEG异常程度与PCPC评分分级正相关(P<0.05)。BIS、aEEG对昏迷儿童近期预后均有预测能力,受试者工作特征曲线(ROC)下面积分别为0.909、0.860;以BIS平均值取45、aEEG轻度异常为临界值,BIS、aEEG预测昏迷儿童近期预后不良的敏感度分别为72.73%、81.82%,特异度分别为85.71%、91.84%。结论 BIS平均值、aEEG异常程度与昏迷儿童近期预后密切相关,BIS、aEEG均可用于预测患儿早期预后,aEEG的预测能力优于BIS。
Objective To study the application value of bispectral index(BIS) and amplitude integrated electroencephalogram(aEEG) in the evaluation of short-term prognosis of children with coma.Methods Sixty coma children admitted to the Pediatric Intensive Care Unit(PICU) from June 2016 to March 2018 were enrolled.All patients were accompanied by different degrees of brain injury.All of them had different degrees of brain injury.BIS monitoring was performed and bedside aEEG was recorded after admission.Three months later,pediatric cerebral performance category(PCPC) score was recorded,serum levels of beta-endorphin(β-EP) and neuron-specific enolase(NSE) were measured by time-resolved immunofluorescence and radioimmunoassay respectively to evaluate the short-term prognosis.Results With the decrease of the mean value of BIS,aEEG abnormality aggravated,and serum β-EP and NSE levels increased gradually(P<0.05).Pearson correlation analysis showed that the mean value of BIS was negatively correlated with serum β-EP and NSE levels.The degree of aEEG abnormality was positively correlated with serum β-EP and NSE levels(P<0.05).With the decrease of the mean value of BIS,aEEG abnormality aggravated and the PCPC score was gradually increased(P<0.05).Pearson correlation analysis showed that the mean value of BIS was negatively correlated with the PCPC score,and aEEG abnormality was positively correlated with the PCPC score(P<0.05).Both BIS and aEEG could be used to predictive the short-term prognosis of children with coma.The areas under the receiver operating characteristic(ROC) curve were 0.909 and 0.860 respectively.With the mean value of BIS of 45 and mild aEEG abnormality as the critical values,the sensitivities of BIS and aEEG in predicting poor prognosis of children with coma were 72.73% and 81.82%,respectively,and the specificities were 85.71% and 91.84%,respectively.Conclusion The mean value of BIS and aEEG abnormality are closely related to the short-term prognosis of children with coma.Both BIS and aEEG can be used to predict early prognosis,and the predictive ability of aEEG is better than BIS.
Objective To study the application value of bispectral index(BIS) and amplitude integrated electroencephalogram(aEEG) in the evaluation of short-term prognosis of children with coma.Methods Sixty coma children admitted to the Pediatric Intensive Care Unit(PICU) from June 2016 to March 2018 were enrolled.All patients were accompanied by different degrees of brain injury.All of them had different degrees of brain injury.BIS monitoring was performed and bedside aEEG was recorded after admission.Three months later,pediatric cerebral performance category(PCPC) score was recorded,serum levels of beta-endorphin(β-EP) and neuron-specific enolase(NSE) were measured by time-resolved immunofluorescence and radioimmunoassay respectively to evaluate the short-term prognosis.Results With the decrease of the mean value of BIS,aEEG abnormality aggravated,and serum β-EP and NSE levels increased gradually(P<0.05).Pearson correlation analysis showed that the mean value of BIS was negatively correlated with serum β-EP and NSE levels.The degree of aEEG abnormality was positively correlated with serum β-EP and NSE levels(P<0.05).With the decrease of the mean value of BIS,aEEG abnormality aggravated and the PCPC score was gradually increased(P<0.05).Pearson correlation analysis showed that the mean value of BIS was negatively correlated with the PCPC score,and aEEG abnormality was positively correlated with the PCPC score(P<0.05).Both BIS and aEEG could be used to predictive the short-term prognosis of children with coma.The areas under the receiver operating characteristic(ROC) curve were 0.909 and 0.860 respectively.With the mean value of BIS of 45 and mild aEEG abnormality as the critical values,the sensitivities of BIS and aEEG in predicting poor prognosis of children with coma were 72.73% and 81.82%,respectively,and the specificities were 85.71% and 91.84%,respectively.Conclusion The mean value of BIS and aEEG abnormality are closely related to the short-term prognosis of children with coma.Both BIS and aEEG can be used to predict early prognosis,and the predictive ability of aEEG is better than BIS.
引文
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[11] 肖兴鹏,贾一帆,陈蕾.无痛胃镜检查中脑电双频指数指导下地佐辛最适剂量的选择[J].中国临床研究,2017,30(5):661-663.
[12] 陈建军,司林杰,姚洁,等.脑电双频指数评估弥散性轴索损伤患者脑损伤及预后的临床研究[J].中国急救医学,2017,37(5):458-461.
[13] Selig C,Riegger C,Dirks B,et al.Bispectral index (BIS) and suppression ratio (SR) as an early predictor of unfavourable neurological outcome after cardiac arrest[J].Resuscitation,2014,85(2):221-226.
[14] 董伦,汤灿,张恒柱,等.颅内压及脑电双频指数联合监测在重型颅脑外伤患者术后临床应用中的研究[J].国际外科学杂志,2017,44(7):464-467,封4.
[15] 董鑫,邵换璋,杨亚南,等.心肺脑复苏后患者振幅整合脑电图对脑功能预后的早期评价[J].中华危重病急救医学,2017,29(10):887-892.
[16] 朱玲,胡兰,汤磊.振幅整合脑电图评估PICU意识障碍患儿预后的价值[J].重庆医科大学学报,2016,41(12):1284-1287.
[17] 程可萍,朱品俐,王艳维.振幅整合脑电图在新生儿缺氧缺血性脑病中的诊断价值探讨[J].中华全科医学,2016,14(4):612-614.
[18] 许邦礼,康文清,鄢文海.振幅整合脑电图在足月新生儿脑损伤监测中的应用价值[J].中国小儿急救医学,2016,23(4):231-235.
[19] 邓松清,喻韬,毛萌,等.多导定量分析振幅整合脑电图在脑损伤儿童的临床应用[J].中山大学学报:医学科学版,2017,38(6):894-899.
[2] 李海玲,缪文丽,任红贤,等.不同致病因素急性脑损伤昏迷患者脑电双频指数监测值的研究[J].中华危重病急救医学,2013,25(3):174-176.
[3] 储微,温晓红.振幅整合脑电图对窒息新生儿脑损伤及与近期神经系统预后的相关性研究[J].中国妇幼保健,2014,29(10):1561-1563.
[4] 胡亚美,江载芳.诸福棠实用儿科学[M].7版.北京:人民卫生出版社,2002:100-121.
[5] Hellstr?m-Westas L,Rosén I.Continuous brain-function monitoring:state of the art in clinical practice[J].Semin Fetal Neonatal Med,2006,11(6):503-511.
[6] Tian G,Qin K,Wu YM,et al.Outcome prediction by amplitude-integrated EEG in adults with hypoxic ischemic encephalopathy[J].Clin Neurol Neurosurg,2012,114(6):585-589.
[7] 常冰,魏义胜,胡振杰,等.亚低温联合咪达唑仑对重症病毒性脑炎患儿血清β-EP、NSE水平的影响[J].中国现代药物应用,2016,10(23):115-116.
[8] 陈锋,张芙蓉,孙继民,等.亚低温对重症病毒性脑炎患儿血清及脑脊液NSE、S100B蛋白表达的影响[J].华中科技大学学报(医学版),2017,46(3):291-294.
[9] 何双龙,许健健.亚低温联合咪达唑仑对重症病毒性脑炎患儿血清β-EP、NSE水平的影响[J].中国妇幼保健,2016,31(5):1065-1068.
[10] 王翠,王迪芬.脑电双频指数对判断急性脑损伤昏迷患者预后的价值[J].贵阳医学院学报,2015,40(7):727-729.
[11] 肖兴鹏,贾一帆,陈蕾.无痛胃镜检查中脑电双频指数指导下地佐辛最适剂量的选择[J].中国临床研究,2017,30(5):661-663.
[12] 陈建军,司林杰,姚洁,等.脑电双频指数评估弥散性轴索损伤患者脑损伤及预后的临床研究[J].中国急救医学,2017,37(5):458-461.
[13] Selig C,Riegger C,Dirks B,et al.Bispectral index (BIS) and suppression ratio (SR) as an early predictor of unfavourable neurological outcome after cardiac arrest[J].Resuscitation,2014,85(2):221-226.
[14] 董伦,汤灿,张恒柱,等.颅内压及脑电双频指数联合监测在重型颅脑外伤患者术后临床应用中的研究[J].国际外科学杂志,2017,44(7):464-467,封4.
[15] 董鑫,邵换璋,杨亚南,等.心肺脑复苏后患者振幅整合脑电图对脑功能预后的早期评价[J].中华危重病急救医学,2017,29(10):887-892.
[16] 朱玲,胡兰,汤磊.振幅整合脑电图评估PICU意识障碍患儿预后的价值[J].重庆医科大学学报,2016,41(12):1284-1287.
[17] 程可萍,朱品俐,王艳维.振幅整合脑电图在新生儿缺氧缺血性脑病中的诊断价值探讨[J].中华全科医学,2016,14(4):612-614.
[18] 许邦礼,康文清,鄢文海.振幅整合脑电图在足月新生儿脑损伤监测中的应用价值[J].中国小儿急救医学,2016,23(4):231-235.
[19] 邓松清,喻韬,毛萌,等.多导定量分析振幅整合脑电图在脑损伤儿童的临床应用[J].中山大学学报:医学科学版,2017,38(6):894-899.