Wennervirta Johanna E, Ermes Miikka J, Tiainen S Marjaana, Salmi Tapani K, Hynninen Marja S, Särkelä Mika O K, Hynynen Markku J, Stenman Ulf-Håkan, Viertiö-Oja Hanna E, Saastamoinen Kari-Pekka, Pettilä Ville Y, Vakkuri Anne P
Intensive Care Units, Department of Anesthesiology and Intensive Care Medicine, Helsinki University Hospital, Helsinki, Finland.
Crit Care Med. 2009 Aug;37(8):2427-35. doi: 10.1097/CCM.0b013e3181a0ff84.
To evaluate electroencephalogram-derived quantitative variables after out-of-hospital cardiac arrest.
Prospective study.
University hospital intensive care unit.
Thirty comatose adult patients resuscitated from a witnessed out-of-hospital ventricular fibrillation cardiac arrest and treated with induced hypothermia (33 degrees C) for 24 hrs.
None.
Electroencephalography was registered from the arrival at the intensive care unit until the patient was extubated or transferred to the ward, or 5 days had elapsed from cardiac arrest. Burst-suppression ratio, response entropy, state entropy, and wavelet subband entropy were derived. Serum neuron-specific enolase and protein 100B were measured. The Pulsatility Index of Transcranial Doppler Ultrasonography was used to estimate cerebral blood flow velocity. The Glasgow-Pittsburgh Cerebral Performance Categories was used to assess the neurologic outcome during 6 mos after cardiac arrest. Twenty patients had Cerebral Performance Categories of 1 to 2, one patient had a Cerebral Performance Categories of 3, and nine patients had died (Cerebral Performance Categories of 5). Burst-suppression ratio, response entropy, and state entropy already differed between good (Cerebral Performance Categories 1-2) and poor (Cerebral Performance Categories 3-5) outcome groups (p = .011, p = .011, p = .008) during the first 24 hrs after cardiac arrest. Wavelet subband entropy was higher in the good outcome group between 24 and 48 hrs after cardiac arrest (p = .050). All patients with status epilepticus died, and their wavelet subband entropy values were lower (p = .022). Protein 100B was lower in the good outcome group on arrival at ICU (p = .010). After hypothermia treatment, neuron-specific enolase and protein 100B values were lower (p = .002 for both) in the good outcome group. The Pulsatility Index was also lower in the good outcome group (p = .004).
Quantitative electroencephalographic variables may be used to differentiate patients with good neurologic outcomes from those with poor outcomes after out-of-hospital cardiac arrest. The predictive values need to be determined in a larger, separate group of patients.
评估院外心脏骤停后脑电图衍生的定量变量。
前瞻性研究。
大学医院重症监护病房。
30名成年昏迷患者，他们从院外目击的心室颤动心脏骤停中复苏，并接受诱导低温（33摄氏度）治疗24小时。
无。
从患者入住重症监护病房开始直至拔管或转至病房，或心脏骤停后5天，记录脑电图。计算爆发抑制率、反应熵、状态熵和小波子带熵。检测血清神经元特异性烯醇化酶和蛋白100B。使用经颅多普勒超声的搏动指数评估脑血流速度。采用格拉斯哥-匹兹堡脑功能分类评估心脏骤停后6个月内的神经学转归。20例患者的脑功能分类为1至2级，1例患者为3级，9例患者死亡（脑功能分类为5级）。在心脏骤停后的最初24小时内，良好（脑功能分类1 - 2级）和不良（脑功能分类3 - 5级）转归组之间的爆发抑制率、反应熵和状态熵已经存在差异（p = 0.011，p = 0.011，p = 0.008）。在心脏骤停后24至48小时，良好转归组的小波子带熵更高（p = 0.050）。所有癫痫持续状态的患者均死亡，且他们的小波子带熵值更低（p = 0.022）。入住重症监护病房时，良好转归组的蛋白100B更低（p = 0.010）。低温治疗后，良好转归组的神经元特异性烯醇化酶和蛋白100B值更低（两者p = 0.002）。良好转归组的搏动指数也更低（p = 0.004）。
定量脑电图变量可用于区分院外心脏骤停后神经学转归良好和不良的患者。其预测价值需要在更大规模的独立患者群体中确定。
