Maurer E, Milewski P, Ulrich C
Abteilung für Anästhesiologie, Operative Intensivmedizin und Schmerztherapie, Klinik am Eichert, Göppingen.
Unfallchirurg. 2005 Feb;108(2):102-8. doi: 10.1007/s00113-004-0820-0.
The objective of this study was to evaluate the prognostic value of early somatosensory evoked potentials (SEP) in patients with brain injury. A total of 85 patients who had been intubated and mechanically ventilated were investigated retrospectively. The results were compared to the Glasgow Coma Scale (GCS). The Glasgow Coma Scale as determined by the emergency doctor at the accident site, an SEP score, and the outcome of the patient were compared. There was no correlation of the Glasgow Coma Scale with the outcome. Probably the reason for this finding is the short interval of time between accident and evaluation of the GCS so that an awakening of the patient a short time after the accident is not reflected by the GCS. On the other hand, there was a significant correlation of the SEP score in the first examination after the accident with the outcome (p<0.001). SEP gave no false pessimistic prognoses. All patients without cortical responses either in one hemisphere or both hemispheres remained in coma vigile or died because of their brain injury. If cortical responses over both hemispheres remained normal, it was highly probable that the patients were later not severely handicapped. A reliable prognosis based on SEP is possible at a time when the clinical examination of the patient is limited due to sedating drugs. Repetitive examinations can monitor the course of recovery and correct false optimistic prognoses. The method may be applied at bedside and requires minimal time and little financial effort.
本研究的目的是评估早期体感诱发电位（SEP）对脑损伤患者的预后价值。对85例已插管并接受机械通气的患者进行了回顾性研究。将结果与格拉斯哥昏迷量表（GCS）进行比较。比较了事故现场急诊医生确定的格拉斯哥昏迷量表、SEP评分和患者的预后情况。格拉斯哥昏迷量表与预后无相关性。这一发现的原因可能是事故与格拉斯哥昏迷量表评估之间的时间间隔较短，以至于事故后短时间内患者的苏醒情况未被格拉斯哥昏迷量表反映出来。另一方面，事故后首次检查时的SEP评分与预后存在显著相关性（p<0.001）。SEP未给出假阴性预后。所有单侧或双侧半球无皮质反应的患者均处于睁眼昏迷状态或因脑损伤死亡。如果双侧半球的皮质反应均保持正常，则患者后期很可能不会有严重残疾。当由于使用镇静药物而使患者的临床检查受到限制时，基于SEP进行可靠的预后评估是可行的。重复检查可以监测恢复过程并纠正假阳性预后。该方法可在床边应用，所需时间最少且费用低廉。
