CAJ | 학술논문

目的探讨体感诱发电位(SEPs)联合事件相关电位(ERPs)预测昏迷患者预后的临床应用价值.方法从201 1年1月至2014年6月首都医科大学宣武医院神经内科重症监护病房收治的神经重症患者中,纳入53例昏迷患者进行前瞻性队列研究;发病7d内行短潜伏期体感诱发电位(SLSEP)、中潜伏期体感诱发电位(MLSEP)和ERPs[N100、失匹配负波(MMN)]检测;病后3个月行预后追踪,格拉斯哥预后量表(GOS)评分3～5分为预后良好,GOS评分1～2分为预后不良.同时纳入健康对照者30名,同样进行SLSEP、MLSEP和N100、MMN检测.结果昏迷患者与健康对照者比较,N20、N60、N100、MMN振幅降低、潜伏期延长;预后不良患者N20、N60、N100、MMN潜伏期(ms)分别为21.73±2.91、68.67±7.60、114.81±21.60、194.10±55.31,预后良好患者N20、N60、N100、MMN潜伏期(ms)分别为20.74±2.05、64.20±5.29、109.74±21.30、181.00±50.32;预后良好组与预后不良组比较,SLSEP的N20、MLSEP的N60、ERPs的N100和MMN的存在与消失差异有统计学意义(x2值分别为14.60、10.59、14.46和18.12,均P＜0.05).SEPs联合ERPs预测良好预后的敏感度为85.2％,特异度为74.2％,总正确率为86.8％;预测不良预后敏感度为74.2％,特异度为85.2％,总正确率为86.8％.结论双侧N20消失是预测昏迷患者不良预后的可靠指标,双侧N60、N100及MMN存在是预测昏迷患者良好预后的指标.当联合SEPs与ERPs后,预测良好预后与不良预后更加完整准确.
목적 탐토체감유발전위(SEPs)연합사건상관전위(ERPs)예측혼미환자예후적림상응용개치.방법 종201 1년1월지2014년6월수도의과대학선무의원신경내과중증감호병방수치적신경중증환자중,납입53례혼미환자진행전첨성대렬연구;발병7d내행단잠복기체감유발전위(SLSEP)、중잠복기체감유발전위(MLSEP)화ERPs[N100、실필배부파(MMN)]검측;병후3개월행예후추종,격랍사가예후량표(GOS)평분3～5분위예후량호,GOS평분1～2분위예후불량.동시납입건강대조자30명,동양진행SLSEP、MLSEP화N100、MMN검측.결과 혼미환자여건강대조자비교,N20、N60、N100、MMN진폭강저、잠복기연장;예후불량환자N20、N60、N100、MMN잠복기(ms)분별위21.73±2.91、68.67±7.60、114.81±21.60、194.10±55.31,예후량호환자N20、N60、N100、MMN잠복기(ms)분별위20.74±2.05、64.20±5.29、109.74±21.30、181.00±50.32;예후량호조여예후불량조비교,SLSEP적N20、MLSEP적N60、ERPs적N100화MMN적존재여소실차이유통계학의의(x2치분별위14.60、10.59、14.46화18.12,균P＜0.05).SEPs연합ERPs예측량호예후적민감도위85.2％,특이도위74.2％,총정학솔위86.8％;예측불량예후민감도위74.2％,특이도위85.2％,총정학솔위86.8％.결론 쌍측N20소실시예측혼미환자불량예후적가고지표,쌍측N60、N100급MMN존재시예측혼미환자량호예후적지표.당연합SEPs여ERPs후,예측량호예후여불량예후경가완정준학.
Objective To explore the effectiveness of using somatosensory evoked potentials (SEPs) combined with event-related potentials (ERPs) to predict the prognosis of comatose patients in neurologic intensive care units (N-ICU).Methods A prospective cohort study was conducted in 53 comatose patients enrolled from the Department of Neurology,Xuanwu Hospital of Capital Medical University from January 2011 to June 2014.Short-latency somatosensory evoked potentials (SLSEP),middle-latency somatosensory evoked potentials (MLSEP),N100,and mismatch negative (MMN) were recorded in these comatose patients in N-ICU within one week after coma onset.All patients were evaluated with Glasgow Outcome Scale (GOS) in 3 months after onset.GOS grades 3 to 5 were considered the good outcome; while GOS grades 1 and 2 were considered poor.SLSEP,MLSEP,N100 and MMN were also recorded in 30 healthy controls.The consistency between SLSEP,MLSEP,N100,MMN,and prognosis,as well as the prognostic authenticity of SLSEP,MLSEP,N100 and MMN were analyzed.Results The amplitude was smaller and the latency became longer in comatose patients,compared with healthy controls.The latency of N20,N60,N100 and MMN in patients with good outcome was (21.73 ±2.91) ms,(68.67 ±7.60) ms,(114.81 ±21.60) ms and (194.10 ±55.31) ms,respectively.And the latency of N20,N60,N100 and MMN in patients with poor outcome was (20.74 ±2.05) ms,(64.20 ±5.29) ms,(109.74 ±21.30) ms and (181.00 ± 50.32) ms,respectively.The consistency between poor outcome and absence of evoked potentials for N20,N60,N100 and MMN was satisfactory (x2 =14.60,10.59,14.46,18.12 respectively,all P ＜ 0.05).When combined SEPs with ERPs,the sensitivity was 85.2％,specificity was 74.2％,and general correct rate was 86.8％,respectively,for good outcome; the sensitivity was 74.2％,specificity was 85.2％,and general correct rate was 86.8％,respectively,for poor outcome.Conclusions The bilateral absence of N20 has a good power for predicting the poor outcome in comatose patients,while the bilateral existence of N60,N100 and MMN has a good power for predicting the good outcome.The combined use of SEPs and ERPs in evaluating and predicting the outcomes in comatose patients is suggested.