Tobita M, Kuroiwa Y, Komiyama A, Hasegawa O, Miyasaki H, Sugiyama M, Yamada Y
Critical Care and Emergency Medical Center of Yokohama City University School of Medicine, Japan.
No To Shinkei. 1996 Feb;49(2):131-6.
The improved technique of cardiopulmonary resuscitation (CPR) resulted in survival of many patients who had experienced cardiopulmonary arrest (CPA). However, when the recovery of brain function is poor, patients suffer from severe neurological sequelae, including persistent vegetative state. There have been no conclusive methods to predict the outcome of anoxic encephalopathy after CPR. Madl et al (1993) recorded cortical SEP over the parietal scalp electrodes after bilateral median nerve stimulation at the wrists in anoxic patients experiencing CPR. Their results indicated that the median SEP is useful for the early prediction of neurological prognosis after CPR. We studied short and long latency cortical SEPs evoked by the left median nerve stimulation in 18 consecutive anoxic patients within 48 hours after CPR. The absence of N20, N35, P45 indicated mortality of 86.4% (100% in Madl's results). Preserved N60 peak indicated the recovery of consciousness, while Madl's results showed that patients did not regain consciousness when the N60 latency was longer than 121 ms. Neurological prognosis showed the significant correlation with N20, P25 amplitude and not with amplitude ratio (N20 P25/P15 N20). Reduced amplitude of N20 P25 was consistent with the high score of GOS. N20 P25 was greater than 3.7 microV in all patients who regained consciousness. Recording of cortical SEP within 48 hours after CPR was useful for the prediction of neurological outcome.
心肺复苏术（CPR）技术的改进使许多经历过心脏骤停（CPA）的患者得以存活。然而，当脑功能恢复不佳时，患者会遭受严重的神经后遗症，包括持续性植物状态。目前尚无确凿方法来预测心肺复苏术后缺氧性脑病的预后。Madl等人（1993年）在经历心肺复苏的缺氧患者手腕处双侧正中神经刺激后，记录了顶叶头皮电极上的皮质体感诱发电位（SEP）。他们的结果表明，正中SEP有助于早期预测心肺复苏术后的神经预后。我们对18例连续的缺氧患者在心肺复苏后48小时内，通过刺激左侧正中神经诱发的短潜伏期和长潜伏期皮质SEP进行了研究。N20、N35、P45缺失提示死亡率为86.4%（Madl的结果为100%）。保留的N60波峰提示意识恢复，而Madl的结果显示，当N60潜伏期超过121毫秒时患者未恢复意识。神经预后与N20、P25波幅显著相关，与波幅比值（N20 P25/P15 N20）无关。N20 P25波幅降低与格拉斯哥预后评分（GOS）高分一致。所有恢复意识的患者N20 P25均大于3.7微伏。在心肺复苏后48小时内记录皮质SEP有助于预测神经预后。
