中华神经科杂志
中華神經科雜誌
중화신경과잡지
Chinese Journal of Neurology
2011年
1期
38-42
,共5页
卒中%诱发电位,躯体感觉%格拉斯哥昏迷量表%预后
卒中%誘髮電位,軀體感覺%格拉斯哥昏迷量錶%預後
졸중%유발전위,구체감각%격랍사가혼미량표%예후
Stroke%Evoked potentials,somatosensory%Glasgow coma scale%Prognosis
目的 探讨中潜伏期体感诱发电位(middle-latency somatosensory evoked potentials,MLSEP)预测急性重症脑卒中患者预后的应用价值.方法 对70例症状出现7 d内的重症脑卒中患者行格拉斯哥昏迷评分(Glasgow Coma Scale,GCS)、短潜伏期体感诱发电位(short-latency somatosensory evoked potentials,SLSEP)和MLSEP检测,6个月后采用改良Rankin评分和生存与死亡两个预后标准进行预后评估.健康对照组20名行SLSEP和MLSEP检测.统计学分析MLSEP、SLSEP和GSC与预后的一致性及预测的准确性.结果 健康对照组均记录到双侧N20、N35和N60,脑卒中组患者MLSEP波形有缺失,而且病灶侧MLSEP各波消失比例明显高于对侧.双侧N60消失与预后不良(Kappa=0.828,P＜0.01)和死亡(Kappa=0.686,P＜0.01)的一致性均最好.预测准确性分析显示:病灶侧N60消失预测不良预后和死亡的敏感性高达100%,较病灶侧N20消失的敏感性(85.7%)提高了14.3%;双侧N60消失预测预后不良的特异性为100%,与双侧N20消失一致;但预测死亡的特异性为82.9%,不如双侧N20消失(97.1%).结论 MLSEP可反映脑损伤程度,预测预后不良的敏感性高于SLSEP,建议将MLSEP和SLSEP联合用于重症脑损伤后的评估与预后的预测.
目的 探討中潛伏期體感誘髮電位(middle-latency somatosensory evoked potentials,MLSEP)預測急性重癥腦卒中患者預後的應用價值.方法 對70例癥狀齣現7 d內的重癥腦卒中患者行格拉斯哥昏迷評分(Glasgow Coma Scale,GCS)、短潛伏期體感誘髮電位(short-latency somatosensory evoked potentials,SLSEP)和MLSEP檢測,6箇月後採用改良Rankin評分和生存與死亡兩箇預後標準進行預後評估.健康對照組20名行SLSEP和MLSEP檢測.統計學分析MLSEP、SLSEP和GSC與預後的一緻性及預測的準確性.結果 健康對照組均記錄到雙側N20、N35和N60,腦卒中組患者MLSEP波形有缺失,而且病竈側MLSEP各波消失比例明顯高于對側.雙側N60消失與預後不良(Kappa=0.828,P＜0.01)和死亡(Kappa=0.686,P＜0.01)的一緻性均最好.預測準確性分析顯示:病竈側N60消失預測不良預後和死亡的敏感性高達100%,較病竈側N20消失的敏感性(85.7%)提高瞭14.3%;雙側N60消失預測預後不良的特異性為100%,與雙側N20消失一緻;但預測死亡的特異性為82.9%,不如雙側N20消失(97.1%).結論 MLSEP可反映腦損傷程度,預測預後不良的敏感性高于SLSEP,建議將MLSEP和SLSEP聯閤用于重癥腦損傷後的評估與預後的預測.
목적 탐토중잠복기체감유발전위(middle-latency somatosensory evoked potentials,MLSEP)예측급성중증뇌졸중환자예후적응용개치.방법 대70례증상출현7 d내적중증뇌졸중환자행격랍사가혼미평분(Glasgow Coma Scale,GCS)、단잠복기체감유발전위(short-latency somatosensory evoked potentials,SLSEP)화MLSEP검측,6개월후채용개량Rankin평분화생존여사망량개예후표준진행예후평고.건강대조조20명행SLSEP화MLSEP검측.통계학분석MLSEP、SLSEP화GSC여예후적일치성급예측적준학성.결과 건강대조조균기록도쌍측N20、N35화N60,뇌졸중조환자MLSEP파형유결실,이차병조측MLSEP각파소실비례명현고우대측.쌍측N60소실여예후불량(Kappa=0.828,P＜0.01)화사망(Kappa=0.686,P＜0.01)적일치성균최호.예측준학성분석현시:병조측N60소실예측불량예후화사망적민감성고체100%,교병조측N20소실적민감성(85.7%)제고료14.3%;쌍측N60소실예측예후불량적특이성위100%,여쌍측N20소실일치;단예측사망적특이성위82.9%,불여쌍측N20소실(97.1%).결론 MLSEP가반영뇌손상정도,예측예후불량적민감성고우SLSEP,건의장MLSEP화SLSEP연합용우중증뇌손상후적평고여예후적예측.
Objective To explore the effectiveness of using middle-latency somatosensory evoked potentials (MLSEP) to predict the prognosis in patients with acute severe stroke. Methods MLSEP, shortlatency somatosensory evoked potentials (SLSEP), and Glasgow Coma Scale (GCS) were recorded in 70 acute severe supratentorial stroke patients within 1 week after onset. All patients were evaluated with modified Rankin Scale (mRS) and follow-up in 6 months after onset. SLSEP and MLSEP were recorded in 20 normal controls. The consistency between MLSEP, SLSEP, GCS and prognosis, as well as the prognostic authenticity of MLSEP, SLSEP, and GCS were analyzed. Results Bilateral N20, N35, and N60 exited in all normal controls. Some waves of MLSEP were absent in stroke patients, and the proportion of absent waves in ipsilateral MLSEP was higher than in contralateral MLSEP. The consistency between bilateral absence of N60 and unfavorable outcome ( Kappa = 0.828, P ＜ 0.01 ), and between bilateral absence of N60 and death ( Kappa = 0.686, P ＜ 0.01 ) was satisfactory. By using the prognostic authenticity analysis of predictors, the ipsilateral absence of N60 showed the highest sensitivity ( 100% ) for unfavorable outcome and death, which added 14.3% compared with the sensitivity of ipsilateral absence of N20 ( 85.7% ). Bilateral absence of N60 showed a high specificity of 100% for unfavorable outcome, which equaled bilateral absence of N20.However, it showed a lower specificity ( 82.9% ) for death, than bilateral absence of N20 (97.1% ).Conclusions MLSEP was able to reflect the degree of brain injury and showed higher sensitivity than SLSEP for predicting unfavorable outcomes. Therefore combined use of MLSEP and SLSEP in evaluating and predicting the outcomes in brain injuries is suggested.
