[定量脑电图对儿科重症监护病房非创伤性意识障碍儿童不良预后的预测价值]
[Predictive value of quantitative electroencephalogram in the poor outcome of children with non-traumatic disturbance of consciousness in pediatric intensive care unit].
作者信息
Zhao W, Liu Y, Pan H R, Gao K, Hang H
机构信息
Department of Pediatrics, the First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, China.
出版信息
Zhonghua Er Ke Za Zhi. 2021 May 2;59(5):374-379. doi: 10.3760/cma.j.cn112140-20201126-01058.
To explore the predictive value of quantitative electroencephalogram (qEEG) in the poor outcome of children with non-traumatic disturbance of consciousness (DoC) in the pediatric intensive care unit (PICU). A prospective study was conducted. From January 2019 to May 2019, a total of 62 patients aged from 1 month to 11 years with non-traumatic DoC in the PICU of the First Affiliated Hospital of Bengbu Medical College were enrolled. Bedside monitoring with NicoletOne monitor was performed within 24 hours after admission, and qEEG parameters, including amplitude-integrated electroencephalogram (aEEG), relative alpha variability (RAV), relative band power (RBP), and spectral entropy (SE) were recorded. The state of consciousness was assessed with modified pediatric Glasgow coma scale (MPGCS) before monitoring. According to the pediatric cerebral performance category score at 1 year after discharge, the enrolled subjects were divided into good and poor outcome groups. The association between these variables and the poor outcome was analyzed by univariate and multivariate logistic regression analysis, and the predictive performance was analyzed by receiver operator characteristic (ROC) curve. There were 39 males and 23 females, with the age of 12.0 (5.8, 24.0) months. Fifty patients (81%) were in the good outcome group and 12 patients (19%) in the poor outcome group. The univariate Logistic regression analysis showed that age (1.037, 95% 1.001-1.074, 0.041), severe abnormal aEEG (128.000, 95% 10.274-1 594.656, 0.01), RAV (0.877, 95% 0.810-0.949, 0.001), SE (0.892, 95% 0.814-0.978, 0.015), and MPGCS score (0.511, 95% 0.349-0.747, 0.001) were significantly associated with the poor outcome. However, the multivariate Logistic regression analysis showed that only severe abnormal aEEG (315.692, 95% 6.091-16 362.298, 0.004) and RAV (0.808, 95% 0.664-0.983, 0.033) were significantly associated with the poor outcome. The area under the curve (AUC) of the aEEG and RAV in predicting the poor outcome were 0.848 (95% 0.735-0.927, 0.01) and 0.847 (95% 0.733-0.926, 0.01), respectively. The optimal cut-off value was severe abnormal for the aEEG and 38% for the RAV, with sensitivity of 67% and 83%, specificity of 98% and 84%, positive predictive value of 89% and 55%, negative predictive value of 92% and 95%, and Youden index of 0.647 and 0.673, respectively. The AUC of the novel combined index of aEEG and RAV for predicting the poor outcome was 0.974 (95% 0.898-0.998, 0.01). The aEEG and RAV are reliable predictors for the poor outcome of children with non-traumatic DoC, and the novel combined index of aEEG and RAV can improve the predictive performance. The qEEG can be used as a routine method for outcome assessment due to its good objectivity.
探讨定量脑电图(qEEG)对儿科重症监护病房(PICU)中非创伤性意识障碍(DoC)患儿不良预后的预测价值。进行了一项前瞻性研究。2019年1月至2019年5月,蚌埠医学院第一附属医院PICU共纳入62例年龄1个月至11岁的非创伤性DoC患儿。入院后24小时内使用NicoletOne监护仪进行床边监测,记录qEEG参数,包括振幅整合脑电图(aEEG)、相对阿尔法变异性(RAV)、相对频段功率(RBP)和频谱熵(SE)。监测前用改良小儿格拉斯哥昏迷量表(MPGCS)评估意识状态。根据出院后1年的小儿脑功能分类评分,将纳入的受试者分为预后良好组和预后不良组。通过单因素和多因素逻辑回归分析这些变量与不良预后之间的关联,并通过受试者工作特征(ROC)曲线分析预测性能。研究对象共39例男性和23例女性,年龄为12.0(5.8,24.0)个月。50例(81%)为预后良好组,12例(19%)为预后不良组。单因素逻辑回归分析显示,年龄(1.037,95%可信区间1.001 - 1.074,P = 0.041)、aEEG严重异常(128.000,95%可信区间10.274 - 1594.656,P = 0.01)、RAV(0.877,95%可信区间0.810 - 0.949,P = 0.001)、SE(0.892,95%可信区间0.814 - 0.978,P = 0.015)和MPGCS评分(0.511,95%可信区间0.349 - 0.747,P = 0.001)与不良预后显著相关。然而,多因素逻辑回归分析显示,只有aEEG严重异常(315.692,95%可信区间6.091 - 16362.298,P = 0.004)和RAV(0.808,95%可信区间0.664 - 0.983,P = 0.033)与不良预后显著相关。aEEG和RAV预测不良预后的曲线下面积(AUC)分别为0.848(95%可信区间0.735 - 0.927,P = 0.01)和0.847(95%可信区间0.733 - 0.926,P = 0.01)。aEEG的最佳截断值为严重异常,RAV的最佳截断值为38%,敏感性分别为67%和83%,特异性分别为98%和84%,阳性预测值分别为89%和55%,阴性预测值分别为92%和95%,约登指数分别为0.647和0.673。aEEG和RAV联合新指标预测不良预后的AUC为0.974(95%可信区间0.898 - 0.998,P = 0.01)。aEEG和RAV是预测非创伤性DoC患儿不良预后的可靠指标,aEEG和RAV联合新指标可提高预测性能。由于qEEG具有良好的客观性,可作为评估预后的常规方法。