摘要
目的对大脑半球大面积梗死（MCHI）患者发病急性期不同时间段脑电图变化的分析,确定脑电图预测预后的最佳时机。方法共72例MCHI患者分别于发病第1~3和4~7天行脑电图监测,比较不同时间段脑电图模式和Synek分级,预测预后之准确性,发病后3个月采用Glasgow预后分级（GOS）评估预后。结果 72例患者发病后3个月良好预后占62.50%（45/72）、不良预后37.50%（27/72）。发病第1~3天（RR=0.357,95%CI：0.153~0.834,Mantel-Haenszelχ2=6.147,P=0.013）和第4~7天（RR=0.240,95%CI：0.102~0.564,Mantel-Haenszelχ~2=13.601,P=0.000）良性型脑电图模式为MCHI患者预后之保护因素,其预测良好预后率为82.14%（23/28）~85.71%（30/35）,准确度为62.50%~72.22%;发病第4~7天恶性型脑电图模式为MCHI患者预后之危险因素（RR=2.909,95%CI：1.611~5.253,Mantel-Haenszelχ~2=11.110,P=0.001）,其预测不良预后率为66.67%（16/24）,准确度为73.63%。脑电图Synek分级与GOS评分在发病后第1~3（rs=-0.354,P=0.002）和4~7天（rs=-0.417,P=0.000）均呈负相关,提示Synek分级越高、预后越差。发病第4~7天脑电图Synek分级的预测准确度更高（83.33%对70.78%;χ~2=4.000,P=0.039）,与实际预后一致性更佳（Kappa检验：κ=0.639,95%CI：0.522~0.746对κ=0.406,95%CI：0.353~0.459;P=0.001）、辨别力更强（受试者工作特征曲线下面积：0.86±0.05,95%CI：0.761~0.958对0.69±0.07,95%CI：0.554~0.822;P=0.002）。结论 MCHI患者发病第1~3天脑电图模式和Synek分级可以作为脑损伤严重程度评估和指导治疗选择的参考指标,发病第4~7天脑电图Synek分级预测预后的准确度可以作为长期预后预测和医疗决策的参考指标。
ObjectiveTo determine the optimal timing of electroencephalogram（EEG） inpredicting the outcome in patients with massive cerebral hemispheric infarction（MCHI） by evaluating andcomparing the EEG changes during different acute stages after onset.MethodsA total of 72 MCHIpatients were selected to be monitored by bedside EEG at two stages： 1-3 and 4-7 d after onset,respectively. The outcome after 3 months was assessed as good [Glasgow Outcome Scale（GOS） score 3-5]or poor（GOS score 1-2）. Then the predictive accuracy of EEG patterns and gradings（the Synek scale）were calculated and compared between two stages to confirm the optimal timing of prediction.ResultsIn72 cases, 62.50%（45/72） had good and 37.50%（27/72） had poor outcome 3 months after onset. BenignEEG patterns were protective factors for the outcome of MCHI（1-3 d： RR = 0.357, 95% CI： 0.153-0.834,Mantel- Haenszel χ~2= 6.147, P = 0.013; 4-7 d： RR = 0.240, 95% CI： 0.102-0.564, Mantel- Haenszel χ2=13.601, P = 0.000） and they could predict good outcome with incidence rate of 82.14%（23/28）-85.71%（30/35） and the accuracy of 62.50%-72.22%. Malignant EEG patterns at 4-7 d were risk factors for theoutcome of MCHI（RR = 2.909, 95% CI： 1.611-5.253, Mantel- Haenszel χ2= 11.110, P = 0.001）, and theycould predict poor outcome with incidence rate of 66.67%（16/24） and the accuracy of 73.63%. There wasa significant negative correlation between the Synek scale and GOS score both during 1-3 d（rs=- 0.354, P =0.002） and 4-7 d（rs=- 0.417, P = 0.000） after onset, indicating the high er the Synek scale was, the worsethe outcome would be. The accuracy（83.33% vs 70.78%; χ~2= 4.000, P= 0.039）, consistency（Kappa test：κ = 0.639, 95%CI： 0.522-0.746 vs κ = 0.406, 95%CI： 0.353-0.459; P 0.86 ±0.05, 95%CI： 0.761-0.958 vs 0.69 ± 0.07, 95%CI： 0.554-0.822; P = 0.001） and area under curves（= 0.002） of the Synek scale for predictionoCf olnocnlgu-steiormns outcome during 4-7 d after onset were significantly
出处
《中国现代神经疾病杂志》
CAS
2015年第12期950-955,共6页
Chinese Journal of Contemporary Neurology and Neurosurgery
基金
国家临床重点专科建设项目-神经内科
国家临床重点专科建设项目-重症医学科
国家高技术研究发展计划(863计划)项目(项目编号:2015AA020514)~~
关键词
脑梗死
脑电描记术
预后
敏感性与特异性
Brain infarction
Electroencephalography
Prognosis
Sensitivity and specificity
