Madl C, Grimm G, Kramer L, Yeganehfar W, Sterz F, Schneider B, Kranz A, Schneeweiss B, Lenz K
Department of Medicine IV, University of Vienna, Austria.
Lancet. 1993 Apr 3;341(8849):855-8. doi: 10.1016/0140-6736(93)93061-5.
Prediction of individual outcome after cardiopulmonary resuscitation is of major medical, ethical, and socioeconomic interest but uncertain. We studied the early predictive potency of evoked potential recording after cardiac arrest in 66 resuscitated patients who returned to spontaneous circulation but were unconscious and mechanically ventilated. Detailed long-latency and short-latency sensory evoked potentials were recorded and neurological evaluations were done 4-48 h after admission to intensive care. In all 17 patients with favourable outcome (cerebral performance categories 1 and 2) the cortical evoked potential N70 peak, a reliable measure of cortical function, was detected between 74 and 116 ms. In 49 patients with bad outcome (categories 4 and 5) the N70 peak was absent in 35 or found with a delay between 121 and 171 ms in 14 (p < 0.05 vs favourable outcome). Thus the predictive ability was 100% with cutoff of 118 ms. To confirm reproducibility and validity, repeated tracings, and linked-earlobe referenced techniques were done and gave similar results. Early recording of long-latency evoked potentials after cardiopulmonary resuscitation is highly predictive of outcome.
心肺复苏后个体预后的预测具有重大的医学、伦理和社会经济意义，但具有不确定性。我们对66例恢复自主循环但仍昏迷且接受机械通气的复苏患者进行了研究，观察心脏骤停后诱发电位记录的早期预测效能。在重症监护病房入院后4 - 48小时记录详细的长潜伏期和短潜伏期感觉诱发电位，并进行神经学评估。在所有17例预后良好（脑功能分级为1级和2级）的患者中，可靠反映皮质功能的皮质诱发电位N70波峰在74至116毫秒之间被检测到。在49例预后不良（分级为4级和5级）的患者中，35例未检测到N70波峰，14例延迟出现，延迟时间在121至171毫秒之间（与预后良好组相比，p < 0.05）。因此，以118毫秒为临界值时，预测能力为100%。为了证实可重复性和有效性，进行了重复描记以及耳垂参考技术，结果相似。心肺复苏后早期记录长潜伏期诱发电位对预后具有高度预测性。
