Habeych Miguel E, Moshayedi Pouria, Rittenberger Jon C, Gunn Scott R
Department of Anesthesiology, University of Cincinnati, Cincinnati, OH, USA.
Intraoperative Neurophysiological Monitoring Group, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Clin Exp Emerg Med. 2019 Jun;6(2):177-182. doi: 10.15441/ceem.18.015. Epub 2019 Feb 12.
A 34-year-old male was brought to the hospital with a chest gunshot wound. Pulseless upon arrival, blood pressure was absent for 10 minutes. A thoracotomy resulted in return of spontaneous circulation. On hospital day 5, with brainstem reflexes present, he was unresponsive to call or pain, exhibited generalized hyperreflexia and bilateral Babinskys. Median nerve somatosensory evoked potentials (mSSEPs) and brainstem auditory evoked potentials were obtained. International Federation of Clinical Neurophysiology recommendations for mSSEPs and brainstem auditory evoked potentials were followed. Despite absence of the N20 responses from cortical mSSEPs no withdrawal from care was agreed upon. After awaking on day 7, mSSEPs were repeated and present. The patient survived and was discharged with minor deficits. Bilateral absence of N20 responses from mSSEPs performed beyond 48 hours after resuscitation from cardiac arrest is highly associated with bad neurological outcomes. However, variation due to hypothermia, noisy signals, medications, and brain hypo-perfusion must be taken into account.
一名34岁男性因胸部枪伤被送往医院。到达时无脉搏，血压测不出达10分钟。开胸术后恢复自主循环。在住院第5天，患者脑干反射存在，但对呼叫或疼痛无反应，表现为全身反射亢进及双侧巴氏征阳性。进行了正中神经体感诱发电位（mSSEPs）和脑干听觉诱发电位检查。遵循了国际临床神经生理学联合会关于mSSEPs和脑干听觉诱发电位的建议。尽管皮层mSSEPs未引出N20反应，但并未达成放弃治疗的共识。在第7天醒来后，再次进行mSSEPs检查，结果显示有反应。患者存活并出院，遗留轻度功能缺损。心脏骤停复苏后48小时以上进行的mSSEPs双侧未引出N20反应与不良神经学预后高度相关。然而，必须考虑到体温过低、信号嘈杂、药物及脑灌注不足等因素导致的变异情况。
