摘要
目的探讨准确、可靠、客观的床旁持续植物状态评估方法。方法对34例脑损害后昏迷转为持续植物状态的患者进行脑功能评估。临床指标包括意识状态、7项脑干反射、4项脑神经支配活动、3项脊髓反射、1项脊髓自动反射和2项脊神经支配活动;神经电生理指标包括脑电图(Youg 分级评估标准)、脑干听觉诱发电位和短潜伏期体感诱发电位(Cant 分级评估标准)。结果缺血缺氧性脑损害(30/34,88.2%)是最常见的脑损害原因。意识状态从早期浅度、中度或深度昏迷转为睁眼昏迷,脑干反射和脑神经支配的活动全部或部分存在,肢体自主运动部分存在或消失,脊髓反射全部或部分存在,脊髓自动反射全部或部分存在,脊髓病理反射部分阳性。脑电图判定Ⅰ级和Ⅵ级的分别为64.5%(20/31)和29.0%(9/31),Ⅲ级和Ⅳ级的共6.5%(2/31)。脑干听觉诱发电位判定Ⅰ级、Ⅱ级和Ⅲ级的分别为34.8%(8/23)、21.7%(5/23)和43.5%(10/23)。短潜伏期体感诱发电位判定Ⅰ级和Ⅲ级的分别为43.5%(10/23)和52.2%(12/23),Ⅱ级的仅4.4%(1/23)。全部34例患者中死亡10例(29.4%),在35～90d 内意识清醒者4例(11.8%)。结论临床指标符合持续植物状态患者的脑功能状态存在差异,多项电生理技术的联合可对其做出准确、客观、可靠的评定,并为临床医疗决策提供重要参考意见。
Objective To investigate an accurate, reliable and objective method to evaluate persistent vegetative state at bedside. Methods The brain function of 34 cases with persistent vegetative state as a result of acute brain injury was evaluated, involving clinical examinations and neuroelectrophysiological evaluations（ EEG, BAEP, SLSEP）. Results The most common cause of brain damage was anoxic encephalopathy （30/34,88. 2% ）. The patients were in mild, moderate or deep coma with complete or partial existence of brainstem reflection, activities distributed by cerebral nerves, voluntary extremity activities, spinal cord reflection and automatic spinal cord reflection as well as partial existence of pathologic reflection. According to the Young Criteria of EEG, 64. 5% （20/31） and 29.0% （9/31） of the cases were in grade Ⅰand Ⅵrespectively, 6. 5% （2/31） were in grade Ⅲand Ⅳ. According to the Cant Criteria of evoked potential, 34. 8% （ 8/23 ）, 21.7% （ 5/23 ） and 43.5% （ 10/23 ） of the cases were in grade Ⅰ, Ⅱand HI of brainstem auditory evoked potential, respectively. 43.5% （ 10/23 ）, 4. 4% （ 12/23 ） and 52.2% （12/23） were in grade Ⅰ, Ⅱand Ⅲof short-latency somatosensory evoked potential respectively. 29.4% （10/34） of 34 cases died, and 11.8% （4/34） resuscitated during 35--90 days. Conclusion Combination of multiple neuroelectrophysiological tests was an accurate, reliable and objective approach to evaluate the brain function of patients with persistent vegetative state, which provides evidence for decision-making in agrypnotic therapy.
出处
《中华神经科杂志》
CAS
CSCD
北大核心
2007年第5期329-332,共4页
Chinese Journal of Neurology
基金
北京市科委资助项目(953304003)
关键词
持续植物人状态
脑电描记术
诱发电位
预后
Persistent vegetative state
Electroencephalography
Evoked potentials
Prognosis
