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爆发抑制在患有获得性脑损伤的昏迷儿童中对光刺激有反应。

Burst-suppression is reactive to photic stimulation in comatose children with acquired brain injury.

作者信息

Nita Dragos A, Moldovan Mihai, Sharma Roy, Avramescu Sinziana, Otsubo Hiroshi, Hahn Cecil D

机构信息

Division of Neurology and Program in Neurosciences and Mental Health, The Hospital for Sick Children, and Department of Paediatrics, University of Toronto, Toronto, Canada.

Department of Neuroscience and Pharmacology, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark; Division of Physiology and Fundamental Neuroscience, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.

出版信息

Clin Neurophysiol. 2016 Aug;127(8):2921-2930. doi: 10.1016/j.clinph.2016.03.029. Epub 2016 May 14.

Abstract

OBJECTIVE

Burst-suppression is an electroencephalographic pattern observed during coma. In individuals without known brain pathologies undergoing deep general anesthesia, somatosensory stimulation transiently increases the occurrence of bursts. We investigated the reactivity of burst-suppression in children with acquired brain injury.

METHODS

Intensive care unit electroencephalographic monitoring recordings containing burst-suppression were obtained from 5 comatose children with acquired brain injury of various etiologies. Intermittent photic stimulation was performed at 1Hz for 1min to assess reactivity. We quantified reactivity by measuring the change in the burst ratio (fraction of time in burst) following photic stimulation.

RESULTS

Photic stimulation evoked bursts in all patients, resulting in a transient increase in the burst ratio, while the mean heart rate remained unchanged. The regression slope of the change in burst ratio, referred to as the standardized burst ratio reactivity, correlated with subjects' Glasgow Coma Scale scores.

CONCLUSIONS

Reactivity of the burst-suppression pattern to photic stimulation occurs across diverse coma etiologies. Standardized burst ratio reactivity appears to reflect coma severity.

SIGNIFICANCE

Measurement of burst ratio reactivity could represent a simple method to monitor coma severity in critically ill children.

摘要

目的

爆发抑制是昏迷期间观察到的一种脑电图模式。在接受深度全身麻醉且无已知脑部病变的个体中,体感刺激会短暂增加爆发的发生率。我们研究了获得性脑损伤患儿爆发抑制的反应性。

方法

从5名患有各种病因的获得性脑损伤的昏迷患儿中获取包含爆发抑制的重症监护病房脑电图监测记录。以1Hz进行1分钟的间歇性光刺激以评估反应性。我们通过测量光刺激后爆发比率(爆发时间的比例)的变化来量化反应性。

结果

光刺激在所有患者中诱发了爆发,导致爆发比率短暂增加,而平均心率保持不变。爆发比率变化的回归斜率,称为标准化爆发比率反应性,与受试者的格拉斯哥昏迷量表评分相关。

结论

爆发抑制模式对光刺激的反应性在不同的昏迷病因中均会出现。标准化爆发比率反应性似乎反映了昏迷的严重程度。

意义

测量爆发比率反应性可能是监测重症患儿昏迷严重程度的一种简单方法。

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