应用脑电非线性分析检测意识障碍患者残余皮质功能岛相互联系的研究

关键词：脑电描记术  非线性动力学  意识障碍  脑外伤  卒中

Keywords:electroencephalography  nonlinear dynamics  unconsciousness  traumatic brain injury  stroke

摘要：

      摘要 目的：利用脑电非线性分析（NDA）方法观察持续植物状态（PVS）和最小意识状态（MCS）患者对痛觉和听觉刺激的反应，并检测残余皮质功能岛的相互联系。 方法：研究对象均为颅脑外伤或脑卒中患者包括30例PVS患者、20例MCS患者和30例正常意识患者。所有患者依次采集安静闭眼、声音刺激和痛觉刺激三种状态下的脑电信号，并计算脑电信号的互近似熵（C-ApEn）非线性指数。 结果：PVS患者局部和远隔皮质网络受到广泛抑制，对痛觉和听觉刺激几乎无反应。MCS患者局部皮质网络的相互联系明显改善，与正常意识患者组无显著性差异；而健侧远隔皮质网络的相互联系仍明显低于正常意识患者组。 结论：MCS患者局部和远隔皮质网络相互联系均优于PVS患者，脑电非线性分析能够检测意识障碍患者残余皮质功能岛与相关脑区之间的相互联系，提供更多有关知觉性知晓层次的信息。

Abstract:

      Abstract Objective：To investigate the cortical response to painful and auditory stimuli for subjects in persistent vegetative state(PVS) and minimal conscious state(MCS), and measure interconnection of the residual cortical functional islands with electroencephalographic (EEG) non-linear dynamic analysis (NDA). Method：Thirty PVS subjects, 20 MCS subjects and 30 subjects in normal conscious state (NCS) were involved in the study. EEG was recorded under three conditions: eyes closed, auditory stimuli and painful stimuli. EEG non-linear index of cross approximate entropy (C-ApEn) were calculated for all subjects. Result：Interconnection of local and distant cortical networks of patients in PVS was generally suppressed and painful or auditory stimulation could hardly cause any activation of associative cortices from neither local nor distant networks. Instead, interconnection of local cortical networks of patients in MCS improved significantly to some extent very closing to NCS; the only significant difference with the NCS existed in distant unaffected cortical networks. Conclusion：Interconnection of local and distant cortical networks of MCS is superior to PVS. NDA could measure interconnection of residual cortical functional islands with associative cortices in unconscious patients and provide some information at the phenomenal awareness level.