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心脏骤停后昏迷患者神经预后评估的临床神经生理学

Clinical neurophysiology for neurological prognostication of comatose patients after cardiac arrest.

作者信息

Rossetti Andrea O

机构信息

Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois (CHUV), Université de Lausanne (UNIL), Lausanne, Switzerland.

出版信息

Clin Neurophysiol Pract. 2017 Mar 20;2:76-80. doi: 10.1016/j.cnp.2017.03.001. eCollection 2017.

Abstract

Early prognostication of outcome in comatose patients after cardiac arrest represents a daunting task for clinicians, also considering the nowadays commonly used targeted temperature management with sedation in the first 24-48 h. A multimodal approach is currently recommended, in order to minimize the risks of false-positive prediction of poor outcome, including clinical examination off sedation, EEG (background characterization and reactivity, occurrence of repetitive epileptiform features), and early-latency SSEP responses represent the core assessments in this setting; they may be complemented by biochemical markers and neuroimaging. This paper, which relies on a recent comprehensive review, focuses on an updated review of EEG and SSEP, and also offers some outlook into long-latency evoked potentials, which seem promising in clinical use.

摘要

对于心脏骤停后昏迷患者的预后进行早期预测,对临床医生来说是一项艰巨的任务,尤其是考虑到如今在最初24至48小时内常用的目标温度管理联合镇静措施。目前推荐采用多模式方法,以尽量减少预后不良假阳性预测的风险,包括停用镇静后的临床检查、脑电图(背景特征及反应性、重复性癫痫样特征的出现),以及早期潜伏期体感诱发电位反应是这种情况下的核心评估;它们可由生化标志物和神经影像学检查加以补充。本文基于最近的一项全面综述,重点对脑电图和体感诱发电位进行了更新综述,并对长潜伏期诱发电位也进行了一些展望,长潜伏期诱发电位在临床应用中似乎很有前景。

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