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投稿时间：2018-09-18 网络发布日期：2019-06-20
投稿时间：2018-09-18 网络发布日期：2019-06-20
中文摘要: 目的 研究脑电双频指数(BIS)和振幅整合脑电图(aEEG)在昏迷儿童近期预后评价中的应用价值。方法 选择2016年6月至2018年3月儿科重症监护病房(PICU)收治的昏迷儿童 60例,均伴不同程度的脑损伤,入院后接受BIS监测与床旁aEEG记录。3个月后分别采用时间分辨免疫荧光法、放射免疫法测定血清β内啡肽(β-EP)、神经元特异性烯醇化酶(NSE)水平及记录儿童脑功能等级评分(PCPC)评估近期预后情况。结果 随着BIS平均值的降低,aEEG异常程度加重,患儿血清β-EP、NSE水平逐渐升高(P<0.01)；Pearson相关性分析显示BIS平均值与血清β-EP、NSE水平负相关,aEEG异常程度与血清β-EP、NSE水平正相关(P<0.05)。随着BIS平均值的降低,aEEG异常程度更严重,患儿PCPC评分分级逐渐升高(P<0.05)；Pearson相关性分析显示BIS平均值与PCPC评分分级负相关,aEEG异常程度与PCPC评分分级正相关(P<0.05)。BIS、aEEG对昏迷儿童近期预后均有预测能力,受试者工作特征曲线(ROC)下面积分别为0.909、0.860；以BIS平均值取45、aEEG轻度异常为临界值,BIS、aEEG预测昏迷儿童近期预后不良的敏感度分别为72.73%、81.82%,特异度分别为85.71%、91.84%。结论 BIS平均值、aEEG异常程度与昏迷儿童近期预后密切相关,BIS、aEEG均可用于预测患儿早期预后,aEEG的预测能力优于BIS。
Abstract:ObjectiveTo study the application value of bispectral index (BIS) and amplitude integrated electroencephalogram (aEEG) in the evaluation of short-term prognosis of children with coma. Methods Sixty coma children admitted to the Pediatric Intensive Care Unit (PICU) from June 2016 to March 2018 were enrolled.All patients were accompanied by different degrees of brain injury.All of them had different degrees of brain injury.BIS monitoring was performed and bedside aEEG was recorded after admission.Three months later,pediatric cerebral performance category (PCPC) score was recorded,serum levels of beta-endorphin (β-EP) and neuron-specific enolase (NSE) were measured by time-resolved immunofluorescence and radioimmunoassay respectively to evaluate the short-term prognosis. Results With the decrease of the mean value of BIS,aEEG abnormality aggravated,and serum β-EP and NSE levels increased gradually (P<0.05).Pearson correlation analysis showed that the mean value of BIS was negatively correlated with serum β-EP and NSE levels.The degree of aEEG abnormality was positively correlated with serum β-EP and NSE levels (P<0.05).With the decrease of the mean value of BIS,aEEG abnormality aggravated and the PCPC score was gradually increased (P<0.05).Pearson correlation analysis showed that the mean value of BIS was negatively correlated with the PCPC score,and aEEG abnormality was positively correlated with the PCPC score (P<0.05).Both BIS and aEEG could be used to predictive the short-term prognosis of children with coma.The areas under the receiver operating characteristic (ROC) curve were 0.909 and 0.860 respectively.With the mean value of BIS of 45 and mild aEEG abnormality as the critical values,the sensitivities of BIS and aEEG in predicting poor prognosis of children with coma were 72.73% and 81.82%,respectively,and the specificities were 85.71% and 91.84%,respectively. Conclusion The mean value of BIS and aEEG abnormality are closely related to the short-term prognosis of children with coma.Both BIS and aEEG can be used to predict early prognosis,and the predictive ability of aEEG is better than BIS.
keywords: Bispectral index Amplitude-integrated electroencephalograph Children with coma Prognosis Beta-endorphin Neuron-specific enolase Pediatric cerebral performance category scole score
文章编号： 中图分类号： 文献标志码：A
基金项目:江苏省南通市卫生计生委科技项目(WQ2015022，MS12017010-4)
附件
| Author Name | Affiliation |
| YE Lei,SONG Lei,YANG Xiu | Department of Pediatrics,Nantong First People′s Hospital,Nantong，Jiangsu 226001,China |
引用文本：
叶蕾,宋磊,杨秀.脑电双频指数和振幅整合脑电图在昏迷儿童近期预后中的评价[J].中国临床研究,2019,32(6):735-739.
叶蕾,宋磊,杨秀.脑电双频指数和振幅整合脑电图在昏迷儿童近期预后中的评价[J].中国临床研究,2019,32(6):735-739.