重型颅脑损伤患者TCD、神经电生理监测对预后评价的临床研究
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摘要
目的探讨经颅多普勒超声(TCD)及神经电生理监测对重型颅脑损伤患者的预后的评价。方法回顾性分析2015年1月-2017年12月石河子大学第一附属医院神经外科重型颅脑损伤患者出院时预后良好组(格拉斯哥昏迷评分>8分)174例,预后不良组(格拉斯哥昏迷评分≤8分)174例,采用经颅多普勒的诊断技术(TCD)、脑电图(EEG)、体感诱发电位(SEP)、运动诱发电位(MEP)和疾病资料对患者进行监测和评测。结果 348例重型脑损伤患者GCS得分为(9.34±3.25)分,预后不良组年龄≥60者占66.7%,低血压者占74.1%,瞳孔散大者占57.5%,对光反射消失者占70.7%,有心脑血管病者占70.7%,肺部感染者占55.2%、经颅多普勒检查血管重度痉挛者占32.8%,脑电图重度异常者占35.1%,体感诱发电位阳性者占58.0%,运动诱发电位阳性者占66.7%,2组患者比较差异有统计学意义(P<0.05)。结论经颅多普勒异常、神经电生理检测异常在一定程度上反映了重症颅脑损伤患者脑内的紊乱程度,临床评价重症颅脑损伤患者的预后,可根据患者经颅多普勒异常、神经电生理检测异常结果及疾病状况等综合进行分析,有一定的临床指导意义。
Objective The goal of the study was aimed to explore the prognostic factors of TCD and electrophysiological examination in patients with severe craniocerebral injury. Methods 174 good prognosis(GCS>8) and 174 poor prognosis(GCS≤8) who were hospitalized at the First Affiliated Hospital of Shihezi University between January 2015 and December 2017 were collected, and they were measured by Transcranial Doppler(TCD), Electroencephalogram(EEG), Somatosensory Evoked Potential(SEP), and Motor Evoked Potential(MEP). Results Among the 348 severe craniocerebral injury patients, the average GCS score was 9.34 ±3.25. In the poor prognosis group, the group with age more than 60 accounted for 66.7%,hypotension accounted for 74.1%, pupil dilatation accounted for 57.5%, light reflex disappeared accounted for 70.7%, cardiovascular and cerebrovascular diseases accounted for 70.7%, pulmonary infection accounted for 55.2%, severe vasospasm by transcranial Doppler examination accounted for 32.8%, electroencephalogram severe abnormalities accounted for 35.1%, somatosensory evoked potential positive for 58.0%, and motor evoked potential positive for 66.7%. The difference between the two groups was statistically significant(P<0.05). Conclusion To some extent, TCD and electrophysiological examination can be used to evaluate the prognosis of patients with severe craniocerebral injury. Clinical evaluation of the prognosis of patients with severe craniocerebral injury can be based on patients with transcranial Doppler abnormalities, abnormal results of neuro-electrophysiological detection and disease status comprehensive analysis, with certain clinical significance.
Objective The goal of the study was aimed to explore the prognostic factors of TCD and electrophysiological examination in patients with severe craniocerebral injury. Methods 174 good prognosis(GCS>8) and 174 poor prognosis(GCS≤8) who were hospitalized at the First Affiliated Hospital of Shihezi University between January 2015 and December 2017 were collected, and they were measured by Transcranial Doppler(TCD), Electroencephalogram(EEG), Somatosensory Evoked Potential(SEP), and Motor Evoked Potential(MEP). Results Among the 348 severe craniocerebral injury patients, the average GCS score was 9.34 ±3.25. In the poor prognosis group, the group with age more than 60 accounted for 66.7%,hypotension accounted for 74.1%, pupil dilatation accounted for 57.5%, light reflex disappeared accounted for 70.7%, cardiovascular and cerebrovascular diseases accounted for 70.7%, pulmonary infection accounted for 55.2%, severe vasospasm by transcranial Doppler examination accounted for 32.8%, electroencephalogram severe abnormalities accounted for 35.1%, somatosensory evoked potential positive for 58.0%, and motor evoked potential positive for 66.7%. The difference between the two groups was statistically significant(P<0.05). Conclusion To some extent, TCD and electrophysiological examination can be used to evaluate the prognosis of patients with severe craniocerebral injury. Clinical evaluation of the prognosis of patients with severe craniocerebral injury can be based on patients with transcranial Doppler abnormalities, abnormal results of neuro-electrophysiological detection and disease status comprehensive analysis, with certain clinical significance.
引文
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[6]许晖,董江涛,王惠,等.TCD在重型颅脑损伤患者救治中的临床应用研究[J].中华神经外科疾病研究杂志,2018,17(1):76-77.
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[8]叶红,徐冠华,陈黎敏.神经电生理监测在脊柱侧凸矫形手术中的应用[J].中国骨与关节杂志,2018,7(6):445-448.
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[11]李培建,樊娟,张洪钿,等.重型颅脑损伤去骨瓣减压术预后相关因素分析[J].中华神经医学杂志,2013,12(10):1055-1058.
[12]龚勤峰,胡勇,涂杳然,等.老年人跌倒致重型颅脑损伤的危险因素分析[J].中华全科医学,2017,15(4):577-579.
[13]张含芝,张松,金许洪,等.颅内感染与脑出血早期颅内高压经颅多普勒预测效果[J].中华医院感染学杂志,2018,28(9):1360-1362, 1370.
[14]黄日荷,汪渊,吴巧云,等.感染性脑炎患儿脑电图对预后评价的临床研究[J].中华医院感染学杂志,2016,26(11):2599-2601.
[15]赵经纬,罗旭颖,张铮,等.体感诱发电位在重症动脉瘤性蛛网膜下腔出血患者外科或介入干预术前评估中的应用:一项前瞻性观察性队列研究[J].中华危重病急救医学,2018,(3):251-256.
[16]林立超,叶志其,杨建雄,等.神经电生理检测联合头部CT图像对重型颅脑损伤昏迷患者的预后评估价值研究[J].临床医学工程,2015,22(8):963-965.
[17]梁坤,乔慧,刘莉,等.运动诱发电位联合体感诱发电位监测在颈动脉内膜切除术中的应用[J].中华神经外科杂志,2016,32(4):364-367.
[2] Mathieu D, Marroni A, Kot J. Tenth European consensus conferenceon hyperbaric medicine:recommendations for accepted and non-accepted clinical indications and practice of hyperbaric Oxygentreatment[J]. Diving and Hyperbaric Medicine, 2017, 47(1):24-32.
[3] Krauss JK, Jankovic J. Tics secondary to craniocerebral trauma[J].Movement Disorders, 2010, 12(5):776-782.
[4] Atahar, Jamal, Naveen, et al. Full outline of unresponsiveness scoreand the Glasgow coma scale in prediction of pediatric coma[J]. WorldJournal of Emergency Medicine, 2017, 8(1):55-60.
[5]高山,黄家星.经颅多普勒超声(TCD)的诊断技术与临床应用[M].北京:中国协和医科大学出版社,2004.
[6]许晖,董江涛,王惠,等.TCD在重型颅脑损伤患者救治中的临床应用研究[J].中华神经外科疾病研究杂志,2018,17(1):76-77.
[7] Young GB, Mclachlan RS, Kreeft JH, et al. An electroencephalo-graphic classification for coma[J]. The Canadian Journal of Neurolog-ical Sciences. Le Journal Canadien des Sciences Neurologiques,1997, 24(4):320-325.
[8]叶红,徐冠华,陈黎敏.神经电生理监测在脊柱侧凸矫形手术中的应用[J].中国骨与关节杂志,2018,7(6):445-448.
[9] Almekhlafi MA, Demchuk AM, Mishra SA, et al. Malignant embolion transcranial doppler during carotid stenting predict postprocedureDiffusion-Weighted imaging lesions[J]. Stroke; a journal of cerebralcirculation, 2013, 44(5):1317-1322.
[10]宋凌霞,张咏梅,曾芬莲,等.重型颅脑损伤患者医院获得性肺部感染危险因素的Meta分析[J].现代预防医学,2016,43(8):1523-1526.
[11]李培建,樊娟,张洪钿,等.重型颅脑损伤去骨瓣减压术预后相关因素分析[J].中华神经医学杂志,2013,12(10):1055-1058.
[12]龚勤峰,胡勇,涂杳然,等.老年人跌倒致重型颅脑损伤的危险因素分析[J].中华全科医学,2017,15(4):577-579.
[13]张含芝,张松,金许洪,等.颅内感染与脑出血早期颅内高压经颅多普勒预测效果[J].中华医院感染学杂志,2018,28(9):1360-1362, 1370.
[14]黄日荷,汪渊,吴巧云,等.感染性脑炎患儿脑电图对预后评价的临床研究[J].中华医院感染学杂志,2016,26(11):2599-2601.
[15]赵经纬,罗旭颖,张铮,等.体感诱发电位在重症动脉瘤性蛛网膜下腔出血患者外科或介入干预术前评估中的应用:一项前瞻性观察性队列研究[J].中华危重病急救医学,2018,(3):251-256.
[16]林立超,叶志其,杨建雄,等.神经电生理检测联合头部CT图像对重型颅脑损伤昏迷患者的预后评估价值研究[J].临床医学工程,2015,22(8):963-965.
[17]梁坤,乔慧,刘莉,等.运动诱发电位联合体感诱发电位监测在颈动脉内膜切除术中的应用[J].中华神经外科杂志,2016,32(4):364-367.
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