摘要
目的探讨心肺复苏成功患者的脑电双频指数（bispectral index，BIS）与格拉斯哥（glasgow coma scale，GCS）评分、血清神经元特异性烯醇化酶（neuron—specific enolase，NSE）的相关性及其在评估神经功能预后方面的价值。方法选取心脏骤停后心肺复苏成功的昏迷患者，复苏后24h内行BIS监测，同时进行GCS评分及血清NSE水平检测，观察6个月预后。分析三者之问的相关性，比较不同BIS值之间GCS评分和血NSE的差异。分析对比预后良好与不良组之间三者的统计学差异。绘制三种评估方法的受试者工作特征（receiver operating characteristic，ROC）曲线，计算曲线下面积以分析三者对预后的预测价值。应用SPSS16．0统计软件分析，统计方法包括相关分析、t检验或t’检验、χ^2检验或Fisher确切概率法、单因素方差分析。结果BIS值与GCS评分呈正相关（r=0．684），二者与NSE呈负相关（r分别为-0．675和-0．663）。不同的BIS值之间，GCS评分和血清NSE浓度差异具有统计学意义。神经功能预后良好与不良组之间GCS评分（P=0．018）、BIS值（P=0．01）、NSE质量浓度（P=0．01）差异有统计学意义。BIS与NSE对预后的评估价值相当，GCS对预后的评估价值相对较低。结论BIS监测与GCS评分、血清NSE密切相关，是评价患者心肺复苏后昏迷程度及判定神经功能预后的有效指标；在判定预后方面，客观指标BIS与血NSE优于主观指标GCS评分。
Objective To study the correlations among bispectral index （BIS） , Glasgow Coma Scale （GCS）, and serum level of neuron-specific enolase （NSE） for evaluating their performance in the neurological prognosis of comatose survivors after cardiopulmonary resuscitation （CPR）. Methods A total of 40 comatose patients, 27 male and 13 female , age from 19 to 56 years （43.3 ± 9.8 ） years; after successful CPR for cardiac arrest from June 2008 through June 2011, were included in this study regardless of the cause of cardiac arrest. The GCS, NSE, and BIS were simultaneously recorded within 24 h after CPR, and the patients were followed up for six months. The correlations among GCS, NSE, and BIS, as well as the differences in GCS and NSE between different BIS groups were analyzed. The differences in GCS, NSE, and BIS were compared between the poor and good prognosis groups. Receiver operating characteristic （ROC） curve was established to analyze the prognostic value. Data were analyzed using SPSS version 16.0 software. Statistical methods included correlation analysis, t-test or t＇ -test, χ^2 test or Fisher＇ s exact test, and one-factor ANOVA. Results GCS, NSE, and BIS were significantly correlated. BIS was positively correlated with GCS （ r = 0. 684）, whereas BIS and GCS were negatively correlated with NSE （ r =- 0. 675 and r = -0. 663, respectively）. GCS and NSE significantly varied in different BIS groups. Moreover, GCS （P =0. 018）, BIS （P =0. 001 ）, and NSE （P =0. 001 ） were significantly different between patients with poor and good prognosis. The value of BIS in predicting prognosis was higher than that of NSE, whereas that of GCS was relatively lower. Conclusion BIS monitoring was correlated with GCS and NSE. The results indicate that BIS was an effective indicator to evaluate the comatose degree and prognosis of patients after CPR. The objective results of BIS and NSE were superior to the subjective observation of GCS in predicting prognosis.
出处
《中华急诊医学杂志》
CAS
CSCD
北大核心
2015年第1期38-42,共5页
Chinese Journal of Emergency Medicine
