在复苏后目标温度管理期间双谱指数值升高或波动可预测复温后临床癫痫发作。

Increasing or fluctuating bispectral index values during post-resuscitation targeted temperature management can predict clinical seizures after rewarming.

作者信息

Ochiai Kanae, Shiraishi Atsushi, Otomo Yasuhiro, Koido Yuuichi, Kanemura Takashi, Honma Masato

机构信息

Department of Acute Critical Care and Disaster Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan.

Department of Acute Critical Care and Disaster Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan; Emergency and Trauma Center, Kameda Medical Center, 929 Higashicho, Kamogawa City, Chiba 296-8602, Japan.

出版信息

Resuscitation. 2017 May;114:106-112. doi: 10.1016/j.resuscitation.2017.03.011. Epub 2017 Mar 16.

DOI:10.1016/j.resuscitation.2017.03.011

PMID:28315727

Abstract

AIM

To investigate whether an increasing bispectral index (BIS) value during targeted temperature management (TTM) correlates with increased clinical seizures after TTM or worse neurological prognoses after TTM.

METHODS

We performed a retrospective prognostication study of patients who were treated with TTM after recovery of spontaneous circulation from cardiac arrest at a tertiary care hospital. We recorded the BIS regularly during TTM and calculated the correlations of the mean BIS values, standard deviations of the BIS values, and linear regression coefficient of the trend of the BIS values over time as index tests. Study outcomes included the occurrence of clinical seizures after TTM and unfavourable neurological outcomes (defined as a Cerebral Performance Scale score of 3-5). Receiver operating characteristics (ROC) analyses evaluated the predictability of the index tests for the study outcomes.

RESULTS

Of 534 patients with post-cardiac arrest who were admitted to the intensive care unit, 103 were enrolled in this study. Thirty-one patients (30.1%) experienced sequelae in the form of clinical seizures, and 52 (50.5%) had unfavourable neurological outcomes at 30days post-resuscitation. The standard deviation (area under the ROC curve [AUC]=0.763) and the regression coefficient (AUC=0.763) had higher predictability of clinical seizures than the mean BIS value (AUC=0.657); in contrast, the low mean BIS value best predicted unfavourable neurological outcomes (AUC=0.861) compared to the standard deviation (AUC=0.532) and regression coefficient (AUC=0.501).

CONCLUSION

An increase of, or greater fluctuation in, BIS during hypothermia may predict clinical seizures after TTM.

摘要

目的

探讨在目标温度管理（TTM）期间双谱指数（BIS）值升高是否与TTM后临床癫痫发作增加或TTM后更差的神经学预后相关。

方法

我们对一家三级护理医院心脏骤停后自主循环恢复后接受TTM治疗的患者进行了一项回顾性预后研究。在TTM期间定期记录BIS，并计算平均BIS值、BIS值的标准差以及BIS值随时间变化趋势的线性回归系数作为指标测试。研究结果包括TTM后临床癫痫发作的发生情况以及不良神经学结局（定义为脑功能量表评分为3 - 5分）。受试者工作特征（ROC）分析评估了指标测试对研究结果的预测能力。

结果

在入住重症监护病房的534例心脏骤停后患者中，103例纳入本研究。31例患者（30.1%）出现临床癫痫发作形式的后遗症，52例（50.5%）在复苏后30天有不良神经学结局。标准差（ROC曲线下面积[AUC]=0.763）和回归系数（AUC=0.763）对临床癫痫发作的预测能力高于平均BIS值（AUC=0.657）；相比之下，与标准差（AUC=0.532）和回归系数（AUC=0.501）相比，低平均BIS值对不良神经学结局的预测能力最强（AUC=0.861）。