Neurology Unit, Clinique Edith Cavell, Brussels, Belgium.
Curr Opin Crit Care. 2010 Apr;16(2):98-104. doi: 10.1097/MCC.0b013e328337541a.
To summarize a consensus of European authorities about the applications of clinical neurophysiology in the ICU and, particularly, for a clinically useful management of individual patients.
Clinical neurophysiology is useful for diagnosis (epilepsy, brain death, and neuromuscular disorders), prognosis (anoxic ischemic encephalopathy, head trauma, and neurological disturbances of metabolic and toxic origin), and follow-up. The prognostic significance of each test varies as a function of coma etiology. A distinction should be made between tests whose abnormalities are indicative of a poor prognosis (bilateral absence of N20 in anoxic coma, abnormalities suggesting pontine involvement in head trauma) and those whose relative normalcy constitutes an argument for a good prognosis (integrity of brainstem conductions in head trauma, presence of cognitive evoked potentials - mismatch negativity, P300 - irrespective of coma etiology).The highlights of the recent literature mainly concern continuous neuromonitoring for early detection of nonconvulsive seizures, both in adult and neonatal ICU, brain entry into the ischemic penumbra zone, and neuronal functional consequences of intracranial hypertension.
The domain of clinical neurophysiology is similar to that of clinical examination and complementary to that of imaging techniques. It substantially improves the individual management of ICU patients.
总结欧洲权威机构对临床神经生理学在 ICU 中的应用的共识，特别是对个体患者进行临床有用的管理。
临床神经生理学可用于诊断（癫痫、脑死亡和神经肌肉疾病）、预后（缺氧缺血性脑病、头部创伤和代谢和中毒性神经功能障碍）和随访。每个测试的预后意义因昏迷病因而异。应区分那些异常表明预后不良的测试（缺氧性昏迷时 N20 双侧缺失，头部创伤时提示桥脑受累的异常）和那些相对正常表明预后良好的测试（头部创伤时脑干传导完整，存在认知诱发电位 - 失匹配负波、P300 - 与昏迷病因无关）。最近文献的重点主要涉及连续的神经监测，以早期发现非惊厥性癫痫，无论是在成人还是新生儿 ICU 中，脑进入缺血半暗带区，以及颅内压升高对神经元功能的影响。
临床神经生理学的领域与临床检查相似，与影像学技术互补。它极大地改善了 ICU 患者的个体管理。
