Li Hai-ling, Miao Wen-li, Ren Hong-xian, Lin Hui-yan, Wang Hong-ping
Department of Intensive Care Unit, 401st Hospital of Jinan Military Region of PLA, Shandong, China.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2013 Mar;25(3):174-6. doi: 10.3760/cma.j.issn.2095-4352.2013.03.014.
To observe the differences in bispectral index (BIS) in unconscious patients with acute brain injury due to different pathogenic factors, and approach its clinical significance.
A retrospective study was conducted. One hundred and twenty-two unconscious patients with acute brain injured admitted to the intensive care unit (ICU) from March 2009 to August 2012 were involved. According to the pathogenic factors, all patients were divided into direct injury group (n=66) and indirect injury group (n=56). Based on BIS value, all patients were divided into the BIS<60 group (n=80) and the BIS≥60 group (n=42). The BIS was continuously measured for 12 hours during the first 3 days, or 24 hours after stoppage of sedative after admission to ICU. The mean value of BIS (BISmean) was evaluated. The acute physiology and chronic health evaluationII (APACHEII) score, probability of survival (PS) and Glasgow coma score (GCS) were recorded. On the same day, the serum protein S100 and neuron-specific enolase (NSE) were determined. The mortality and the rate of the poor neurological outcome were analyzed.
(1) There were no significant differences in the age, sex, APACHEII score, PS and days of stay in ICU between the direct and indirect injury groups. (2) BISmean and GCS in direct injury group were significantly lower than those of the indirect injury group [BISmean: 39.0 (2.5, 58.0) vs. 59.0 (42.0, 71.0), GCS score: 3 (3, 5) vs. 4 (3, 6), both P<0.01], while serum S100 levels was significantly higher [2.30 (0.75, 6.66) mg/L vs. 0.84 (0.40, 3.62) mg/L, P<0.01]. There was no significant difference in the NSE level between the direct and indirect injury groups. (3) The mortality rate and poor neurological outcome rate in BIS<60 group were significantly higher than the BIS≥60 group (mortality rate: 67.50% vs. 40.48%, poor neurological outcome rate: 86.25% vs. 66.67%, P<0.01 and P<0.05). In the BIS<60 group, there were no significant differences in the mortality and poor neurological outcome rate between direct and indirect injury group.
There are differences in pathogenic factors, the injury mechanism, and the degree of the brain injury between the direct and indirect injury groups. BIS monitoring could help judge the degree of different kinds of brain injury. BIS<60 indicates poor prognosis and neurological outcome in spite of the inducing factor of brain injury.
观察不同致病因素所致急性脑损伤昏迷患者的脑电双频指数（BIS）差异，并探讨其临床意义。
进行回顾性研究。纳入2009年3月至2012年8月入住重症监护病房（ICU）的122例急性脑损伤昏迷患者。根据致病因素，将所有患者分为直接损伤组（n = 66）和间接损伤组（n = 56）。根据BIS值，将所有患者分为BIS<60组（n = 80）和BIS≥60组（n = 42）。在入院后前3天连续测量BIS 12小时，或在停用镇静剂后24小时测量。评估BIS的平均值（BISmean）。记录急性生理与慢性健康状况评分II（APACHEII）、生存概率（PS）和格拉斯哥昏迷评分（GCS）。于同日测定血清蛋白S100和神经元特异性烯醇化酶（NSE）。分析死亡率和神经功能预后不良率。
（1）直接损伤组与间接损伤组在年龄、性别、APACHEII评分、PS及ICU住院天数方面差异无统计学意义。（2）直接损伤组的BISmean和GCS显著低于间接损伤组[BISmean：39.0（2.5，58.0） vs. 59.0（42.0，71.0），GCS评分：3（3，5） vs. 4（3，6），P均<0.01]，而血清S100水平显著高于间接损伤组[2.30（0.75，6.66）mg/L vs. 0.84（0.40，3.62）mg/L，P<0.01]。直接损伤组与间接损伤组的NSE水平差异无统计学意义。（3）BIS<60组的死亡率和神经功能预后不良率显著高于BIS≥≥60组（死亡率：67.50% vs. 40.48%，神经功能预后不良率：86.25% vs. 66.67%，P<0.01和P<0.05）。在BIS<60组中，直接损伤组与间接损伤组的死亡率和神经功能预后不良率差异无统计学意义。
直接损伤组与间接损伤组在致病因素、损伤机制及脑损伤程度方面存在差异。BIS监测有助于判断不同类型脑损伤的程度。无论脑损伤的诱发因素如何，BIS<60提示预后及神经功能结局不良。
