Facco E, Behr A U, Munari M, Baratto F, Volpin S M, Gallo F, Lanzillotta M A, Giron G P
Department of Anesthesiology and Intensive Care, University of Padua, Italy.
Electroencephalogr Clin Neurophysiol. 1998 Nov;107(5):332-8. doi: 10.1016/s0013-4694(98)00080-7.
The aim of this study was to check the prognostic power of auditory brain-stem responses (ABRs) and somatosensory evoked potentials (SEPs) in coma following spontaneous cerebral hemorrhage. Seventy patients comatose following subarachnoidal or hypertensive hemorrhage were submitted to ABR and SEP recordings during the acute phase of clinical course. Twenty-one patients survived (30%), two remained vegetative (2.9%) and 47 died (68.1%). The Glasgow Coma Score (GCS) was significantly related to the outcome (P < 0.001), but showed a low sensitivity, since about 50% of patients with GCS = 5-8 died or remained vegetative. ABRs and SEPs showed a much closer correlation with outcome (P < 0.001): their combined use allowed there to be a sensitivity of 96%, a specificity of 90% and a predictive power of 96%; the relative risk of poor outcome in patients with at least one abnormal modality was equal to 223 times the one for patients with normal evoked potentials. Moreover, in surviving patients a significant relationship appeared to exist between abnormalities of SEPs during the acute phase and the severity of disability. Our results confirm the prognostic effectiveness of short latency evoked potentials in cerebral hemorrhage: they are far superior to clinical data, being able to yield a marked decrease of falsely optimistic predictions.
本研究旨在检验听觉脑干反应（ABR）和体感诱发电位（SEP）对自发性脑出血后昏迷患者的预后评估能力。70例蛛网膜下腔出血或高血压性脑出血后昏迷的患者在临床病程急性期接受了ABR和SEP记录。21例患者存活（30%），2例呈植物状态（2.9%），47例死亡（68.1%）。格拉斯哥昏迷评分（GCS）与预后显著相关（P<0.001），但敏感性较低，因为约50%GCS为5 - 8分的患者死亡或呈植物状态。ABR和SEP与预后的相关性更强（P<0.001）：联合使用时，敏感性为96%，特异性为90%，预测能力为96%；至少有一种异常模式的患者预后不良的相对风险是诱发电位正常患者的223倍。此外，在存活患者中，急性期SEP异常与残疾严重程度之间似乎存在显著关系。我们的结果证实了短潜伏期诱发电位在脑出血中的预后评估有效性：它们远优于临床数据，能够显著减少错误的乐观预测。
