CAJ | 학술논문

目的观察不同致病因素脑损伤昏迷患者脑电双频指数(BIS)的差异,并探讨其临床意义.方法采用回顾性研究方法,选择2009年3月至2012年8月重症监护病房(ICU)急性脑损伤昏迷患者122例,根据致病因素将患者分为直接损伤组(66例)和间接损伤组(56例)；按BIS值分为＜60组(80例)和≥60组(42例).入ICU 3 d内或停用镇静剂24 h后持续监测BIS 12 h,计算其均值(BISmean)；记录患者急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、存活概率(PS)、格拉斯哥昏迷评分(GCS),并于监测当日取静脉血检测S100蛋白、神经元特异性烯醇化酶(NSE)水平,统计患者的病死率与神经学不良转归率.结果 ①不同致病因素两组患者年龄、性别、APACHEⅡ评分、PS及住ICU时间无明显差异.②直接损伤组BISmean、GCS(分)均明显低于间接损伤组[BISmean:39.0(2.5,58.0)比59.0(42.0,71.0),GCS评分:3(3,5)比4(3,6),均P＜0.01],血清S100蛋白(mg/L)明显高于间接损伤组[2.30(0.75,6.66)比0.84(0.40,3.62),P＜0.01],NSE水平两组无明显差异.③BIS＜60组病死率、神经学不良转归率均明显高于BIS≥60组(病死率:67.50％比40.48％,神经学不良转归率:86.25％比66.67％,P＜0.01和P＜0.05)；BIS＜ 60时直接损伤组与间接损伤组病死率、神经学不良转归率无明显差异.结论直接脑损伤与间接脑损伤的致病因素不同、致伤机制不同、损伤程度也不同,BIS监测可以判断不同致病因素的脑损伤程度；无论何种原因引发脑损伤,BIS ＜60均能很好地判断病情不良预后及神经系统不良转归.
목적 관찰불동치병인소뇌손상혼미환자뇌전쌍빈지수(BIS)적차이,병탐토기림상의의.방법 채용회고성연구방법,선택2009년3월지2012년8월중증감호병방(ICU)급성뇌손상혼미환자122례,근거치병인소장환자분위직접손상조(66례)화간접손상조(56례)；안BIS치분위＜60조(80례)화≥60조(42례).입ICU 3 d내혹정용진정제24 h후지속감측BIS 12 h,계산기균치(BISmean)；기록환자급성생이학여만성건강상황평분계통Ⅱ(APACHEⅡ)평분、존활개솔(PS)、격랍사가혼미평분(GCS),병우감측당일취정맥혈검측S100단백、신경원특이성희순화매(NSE)수평,통계환자적병사솔여신경학불량전귀솔.결과 ①불동치병인소량조환자년령、성별、APACHEⅡ평분、PS급주ICU시간무명현차이.②직접손상조BISmean、GCS(분)균명현저우간접손상조[BISmean:39.0(2.5,58.0)비59.0(42.0,71.0),GCS평분:3(3,5)비4(3,6),균P＜0.01],혈청S100단백(mg/L)명현고우간접손상조[2.30(0.75,6.66)비0.84(0.40,3.62),P＜0.01],NSE수평량조무명현차이.③BIS＜60조병사솔、신경학불량전귀솔균명현고우BIS≥60조(병사솔:67.50％비40.48％,신경학불량전귀솔:86.25％비66.67％,P＜0.01화P＜0.05)；BIS＜ 60시직접손상조여간접손상조병사솔、신경학불량전귀솔무명현차이.결론 직접뇌손상여간접뇌손상적치병인소불동、치상궤제불동、손상정도야불동,BIS감측가이판단불동치병인소적뇌손상정도；무론하충원인인발뇌손상,BIS ＜60균능흔호지판단병정불량예후급신경계통불량전귀.
Objective To observe the differences in bispectral index (BIS) in unconscious patients with acute brain injury due to different pathogenic factors,and approch its clinical significance.Methods A retrospective study was conducted.One hundred and twenty-two unconscious patients with acute brain injured admitted to the intensive care unit (ICU) from March 2009 to August 2012 were involved.According to the pathogenic factors,all patients were divided into direct injury group (n=66) and indirect injury group (n=56).Based on BIS value,all patients were divided into the BIS＜60 group (n=80) and the BIS≥60 group (n=42).The BIS was continuously measured for 12 hours during the first 3 days,or 24 hours after stoppage of sedative after admission to ICU.The mean value of BIS (BISmean) was evaluated.The acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score,probability of survival (PS) and Glasgow coma score (GCS) were recorded.On the same day,the serum protein S100 and neuron-specific enolase (NSE) were determined.The mortality and the rate of the poor neurological outcome were analyzed.Results ① There were no significant differences in the age,sex,APACHE Ⅱ score,PS and days of stay in ICU between the direct and indirect injury groups.② BISmean and GCS in direct injury group were significantly lower than those of the indirect injury group [BISmean:39.0 (2.5,58.0) vs.59.0 (42.0,71.0),GCS score:3 (3,5) vs.4 (3,6),both P＜0.01],while serum S100 levels (mg/L) was significandy higher [2.30 (0.75,6.66) vs.0.84(0.40,3.62),P＜0.01].There was no significant difference in the NSE level between the direct and indirect injury groups.③ The mortality rate and poor neurological outcome rate in BIS ＜60 group were significantly higher than the BIS≥60 group (mortality rate:67.50％ vs.40.48％,poor neurological outcome rate:86.25％ vs.66.67％,P＜0.01 and P＜0.05).In the BIS＜60 group,there were no significant differences in the mortality and poor neurological outcome rate between direct and indirect injury group.Conclusions There are differences in pathogenic factors,the injury mechanism,and the degree of the brain injury between the direct and indirect injury groups.BIS monitoring could help judge the degree of different kinds of brain injury.BIS ＜60 indicates poor prognosis and neurological outcome in spite of the inducing factor of brain injury.