急性缺氧性脑卒后患者间断性脑电模式的预后价值。
The prognostic value of discontinuous EEG patterns in postanoxic coma.
机构信息
Clinical Neurophysiology, MIRA - Institute for Biomedical Technology and Technical Medicine, University of Twente, Hallenweg 15, 7522NB Enschede, The Netherlands.
Clinical Neurophysiology, MIRA - Institute for Biomedical Technology and Technical Medicine, University of Twente, Hallenweg 15, 7522NB Enschede, The Netherlands; Department of Neurology, Rijnstate Hospital, Wagnerlaan 55, 6815AD Arnhem, The Netherlands.
出版信息
Clin Neurophysiol. 2018 Aug;129(8):1534-1543. doi: 10.1016/j.clinph.2018.04.745. Epub 2018 May 8.
OBJECTIVE
To assess the value of background continuity and amplitude fluctuations of the EEG for the prediction of outcome of comatose patients after cardiac arrest.
METHODS
In a prospective cohort study, we analyzed EEGs recorded in the first 72 h after cardiac arrest. We defined the background continuity index (BCI) as the fraction of EEG not spent in suppressions (amplitudes < 10 µV for ≥ 0.5 s), and the burst-suppression amplitude ratio (BSAR) as the mean amplitude ratio between non-suppressed and suppressed segments. Outcome was assessed at 6 months and categorized as "good" (Cerebral Performance Category 1-2) or "poor" (CPC 3-5).
RESULTS
Of the 559 patients included, 46% had a good outcome. Combinations of BCI and BSAR resulted in the highest prognostic accuracies. Good outcome could be predicted at 24 h with 57% sensitivity (95% confidence interval (CI): 48-67) at 90% specificity (95%-CI: 86-95). Poor outcome could be predicted at 12 h with 50% sensitivity (95%-CI: 42-56) at 100% specificity (95%-CI: 99-100).
CONCLUSIONS
EEG background continuity and the amplitude ratio between bursts and suppressions reliably predict the outcome of postanoxic coma.
SIGNIFICANCE
The presented features provide an objective, rapid, and reliable tool to assist in EEG interpretation in the Intensive Care Unit.
目的
评估脑电图（EEG）背景连续性和振幅波动对心脏骤停后昏迷患者预后的预测价值。
方法
在一项前瞻性队列研究中，我们分析了心脏骤停后 72 小时内记录的 EEG。我们将背景连续性指数（BCI）定义为 EEG 中未处于抑制状态的部分（振幅<10µV 且持续≥0.5s）的分数，而爆发抑制振幅比（BSAR）则定义为未抑制段和抑制段之间的平均振幅比。预后在 6 个月时进行评估，并分为“良好”（脑功能预后分类 1-2）或“不良”（CPC 3-5）。
结果
在 559 例患者中，46%的患者预后良好。BCI 和 BSAR 的组合可得出最高的预测准确性。在 24 小时时，良好预后的预测敏感度为 57%（95%置信区间[CI]：48-67），特异性为 90%（95%-CI：86-95）。在 12 小时时，不良预后的预测敏感度为 50%（95%-CI：42-56），特异性为 100%（95%-CI：99-100）。
结论
EEG 背景连续性和爆发与抑制之间的振幅比可靠地预测了缺氧性昏迷患者的预后。
意义
所提出的特征为在重症监护病房中辅助 EEG 解读提供了一种客观、快速且可靠的工具。
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