Maurer E, Milewski P
Klinik für Anästhesiologie und operative Intensivmedizin, Klinik am Eichert, Göppingen.
Anasthesiol Intensivmed Notfallmed Schmerzther. 1998 Jul;33(7):430-40. doi: 10.1055/s-2007-994280.
To analyse the diagnostic value of evoked potentials, 176 examinations in 71 sedated, ventilated ICU-patients who could only be examined neurologically on a very limited scale, were registered. We focussed on the evoked potentials, the results having prognostic relevance and being useful in the anatomical localisation of the pathological process. The Glasgow coma scale, neuroradiological findings and the data of the outcome status after hospital or rehabilitation discharge were therefore obtained.
We could show in distinct cases how evoked potentials could make a contribution to localise a pathogenic process. Failures in peripheral nerves, brachial plexus, myelin, brainstem and cerebrum were detected, respectively excluded. In the vast majority of cases, suspected, symptoms were very precisely predicted. This was especially evident in patients suffering from head injury, hypoxia and spinal cord injury. We found that a good outcome can be expected even with high intracranial pressures if the repeatedly registered central conduction time stays normal.
We conclude that non-invasive evoked potentials do enrich the bedside diagnostic pattern in sedated intensive-care unit patients. While neuroradiological methods only allow statements on morphological changing, evoked potentials demonstrate the functional status of the peripheral and central nervous system. This method is easy to learn and the cost involved is justified both financially and from the viewpoint of personnel expenditure.
为分析诱发电位的诊断价值，我们记录了71例在重症监护病房（ICU）接受镇静、机械通气治疗且神经系统检查受限患者的176次检查结果。我们重点关注诱发电位，其结果具有预后相关性，且有助于对病理过程进行解剖定位。因此，我们获取了格拉斯哥昏迷量表、神经放射学检查结果以及患者出院或康复出院后的转归状态数据。
我们在不同病例中证实了诱发电位如何有助于定位致病过程。分别检测到或排除了周围神经、臂丛神经、髓鞘、脑干和大脑的病变。在绝大多数病例中，对可疑症状进行了非常精确的预测。这在头部受伤、缺氧和脊髓损伤患者中尤为明显。我们发现，如果多次记录的中枢传导时间保持正常，即使颅内压升高，也有望获得良好的预后。
我们得出结论，无创诱发电位确实丰富了对镇静重症监护病房患者的床旁诊断模式。神经放射学方法只能对形态学变化进行描述，而诱发电位则可显示周围和中枢神经系统的功能状态。该方法易于掌握，且从经济和人员支出角度来看，所涉及的成本是合理的。
