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心脏骤停后神经预后评估中诱发电位应用的综合综述与实用指南

A Comprehensive Review and Practical Guide of the Applications of Evoked Potentials in Neuroprognostication After Cardiac Arrest.

作者信息

Portell Penadés Eduard, Alvarez Vincent

机构信息

Neurology, Hôpital de Sion, Sion, CHE.

出版信息

Cureus. 2024 Mar 27;16(3):e57014. doi: 10.7759/cureus.57014. eCollection 2024 Mar.

Abstract

Cardiorespiratory arrest is a very common cause of morbidity and mortality nowadays, and many therapeutic strategies, such as induced coma or targeted temperature management, are used to reduce patient sequelae. However, these procedures can alter a patient's neurological status, making it difficult to obtain useful clinical information for the reliable estimation of neurological prognosis. Therefore, complementary investigations are conducted in the early stages after a cardiac arrest to clarify functional prognosis in comatose cardiac arrest survivors in the first few hours or days. Current practice relies on a multimodal approach, which shows its greatest potential in predicting poor functional prognosis, whereas the data and tools to identify patients with good functional prognosis remain relatively limited in comparison. Therefore, there is considerable interest in investigating alternative biological parameters and advanced imaging technique studies. Among these, somatosensory evoked potentials (SSEPs) remain one of the simplest and most reliable tools. In this article, we discuss the technical principles, advantages, limitations, and prognostic implications of SSEPs in detail. We will also review other types of evoked potentials that can provide useful information but are less commonly used in clinical practice (e.g., visual evoked potentials; short-, medium-, and long-latency auditory evoked potentials; and event-related evoked potentials, such as mismatch negativity or P300).

摘要

心肺骤停是当今发病率和死亡率的常见原因,许多治疗策略,如诱导昏迷或目标温度管理,被用于减少患者后遗症。然而,这些程序会改变患者的神经状态,难以获得用于可靠评估神经预后的有用临床信息。因此,在心脏骤停后的早期阶段进行补充检查,以明确昏迷的心脏骤停幸存者在最初几小时或几天内的功能预后。目前的做法依赖于多模态方法,该方法在预测不良功能预后方面显示出最大潜力,而相比之下,识别功能预后良好患者的数据和工具仍然相对有限。因此,人们对研究替代生物参数和先进成像技术研究有很大兴趣。其中,体感诱发电位(SSEP)仍然是最简单、最可靠的工具之一。在本文中,我们将详细讨论SSEP的技术原理、优点、局限性和预后意义。我们还将回顾其他类型的诱发电位,它们可以提供有用信息,但在临床实践中较少使用(例如,视觉诱发电位;短、中、长潜伏期听觉诱发电位;以及事件相关诱发电位,如失配负波或P300)。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d7fa/11046378/fee88f63517f/cureus-0016-00000057014-i01.jpg

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