Lu J P, Che C H, Huang H P
Department of Neurology, Fujian Medical University Union Hospital, Fuzhou 350001, China.
Zhonghua Yi Xue Za Zhi. 2020 Jun 2;100(21):1629-1633. doi: 10.3760/cma.j.cn112137-20190911-02011.
To compare the accuracy of electroencephalography (EEG) grading or amplitude-integrated electroencephalography (aEEG) grading combined with NSE in predicting brain function prognosis after cardiopulmonary cerebral resuscitation (CPR) in adults. The patients who were admitted to Fujian Medical University Union Hospital after CPR from January 2015 to June 2019 were enrolled. Demographic data, Glasgow coma scale (GCS), blood neuron specific enolase (NSE), EEG grading and aEEG grading were collected. The main clinical outcome was the prognosis of brain function (Glasgow-Pittsburgh cerebral performance category, CPC) in patients at 3 months after CPR. Accordingly, the patients were divided into two groups: favorable prognosis group and poor prognosis group, and relevant parameters were compared between the two groups. The predictive ability of EEG grading or aEEG grading combined with NSE for brain function prognosis was evaluated by receiver operating characteristic (ROC) curve. A total of 57 patients were enrolled, with 34 males and 23 females. The average age was (65±19) years old. In terms of Young EEG scales, there was 16 grade 1 cases (28.1%), 24 grade 2-5 cases (42.1%) and 17 grade 6 cases (29.8%), respectively. As for aEEG grading, there was 11 grade Ⅰ cases (19.3%), 25 grade Ⅱ cases (43.9%) and 21 grade Ⅲ cases (36.8%), respectively. There was no significant difference of age, sex, length of stay between the two groups (all 0.05). However, there was significant difference of EEG grading scale, aEEG grading, GCS grading and NSE between the two groups (all 0.05). The area under curve (AUC) of NSE, EEG grading and aEEG grading for predicting brain function prognosis was 0.81, 0.82 and 0.85, respectively (all 0.01). In aEEG grading combined with NSE group, the AUC of was 0.92, and the optimal cut-off point was 4.5, with a sensitivity of 95.8% and a specificity of 79.0%. In EEG grading combined with NSE group, the AUC was 0.90, and the optimal cut-off point was 3.6, with a sensitivity of 92.1% and a specificity of 77.0%. aEEG grading combined with NSE is more accurate in predicting prognosis in patients with cardiopulmonary cerebral resuscitation when compared to EEG grading. Considering its feasibility, aEEG grading combined with NSE is more suitable for clinical application.
比较脑电图(EEG)分级或振幅整合脑电图(aEEG)分级联合神经元特异性烯醇化酶(NSE)预测成年人心肺脑复苏(CPR)后脑功能预后的准确性。选取2015年1月至2019年6月在福建医科大学附属协和医院行心肺复苏术后入院的患者。收集患者的人口统计学资料、格拉斯哥昏迷量表(GCS)、血神经元特异性烯醇化酶(NSE)、EEG分级和aEEG分级。主要临床结局为CPR术后3个月患者的脑功能预后(格拉斯哥-匹兹堡脑功能分级,CPC)。据此,将患者分为两组:预后良好组和预后不良组,比较两组间的相关参数。采用受试者工作特征(ROC)曲线评估EEG分级或aEEG分级联合NSE对脑功能预后的预测能力。共纳入57例患者,其中男性34例,女性23例。平均年龄为(65±19)岁。在EEG分级中,1级16例(28.1%),2 - 5级24例(42.1%),6级17例(29.8%)。在aEEG分级中,Ⅰ级11例(19.3%),Ⅱ级25例(43.9%),Ⅲ级21例(36.8%)。两组患者的年龄、性别、住院时间比较,差异均无统计学意义(均P>0.05)。但两组患者的EEG分级、aEEG分级、GCS分级及NSE比较,差异均有统计学意义(均P<0.05)。NSE、EEG分级和aEEG分级预测脑功能预后的曲线下面积(AUC)分别为0.81、0.82和0.85(均P<0.01)。aEEG分级联合NSE组的AUC为0.92,最佳截断点为4.5,灵敏度为95.8%,特异度为79.0%。EEG分级联合NSE组的AUC为0.90,最佳截断点为3.6,灵敏度为92.1%,特异度为77.0%。与EEG分级相比,aEEG分级联合NSE预测心肺脑复苏患者预后更准确。考虑到其可行性,aEEG分级联合NSE更适合临床应用。