连续脑电监测在成人重症颅脑损伤后意识障碍康复诊疗中的作用

关键词：连续脑电监测  颅脑损伤  意识障碍

Keywords:continuous electroencephalogram monitoring  traumatic brain injury  disorders of consciousness

摘要：

      摘要 目的：通过总结分析成人重症颅脑损伤后意识障碍患者的临床资料及连续脑电监测结果，探讨连续脑电监测在重症颅脑损伤后意识障碍康复诊疗中的应用价值。 方法：收集符合标准的成人重症颅脑损伤后意识障碍患者106例，应用动态脑电设备进行连续脑电监测，依照Young氏分级标准对患者的脑电结果进行EEG分级，并结合脑电反应性检查及相关临床资料，采用Spearman秩相关分析方法和χ2检验进行回顾性分析。 结果：①106例成人重症颅脑损伤患者昏迷、持续植物状态、微弱意识状态等意识障碍类型，与不同脑电分级具有负相关性（r=-0.253），其相关性具有显著性意义(P<0.05)。②意识障碍转归的包括好转、无改善、恶化及患者死亡，与不同脑电分级具有正相关性（r=0.327），其相关性具有显著性意义（P<0.01）。③脑电反应性检查与意识障碍预后转归结果显示，有脑电反应意识障碍患者预后转归优于无反应者，其差异具有显著性意义(P<0.01)。④意识障碍康复治疗中发作性事件的性质判定，连续脑电监测可提供诊断依据。 结论：连续脑电监测有助于判断重症颅脑损伤后患者意识障碍类型、判定发作性事件性质和评估预后，具有重要临床价值。

Abstract:

      Abstract Objective: To summarize and analyze the clinical data and continuous EEG monitoring results of adult patients with consciousness disorder after severe traumatic brain injury, and to explore the application value of continuous EEG monitoring in rehabilitation diagnosis and treatment of consciousness disorder after severe traumatic brain injury. Method: Totally 106 adult patients with consciousness disorder after severe traumatic brain injury were collected. Continuous EEG monitoring was performed with dynamic EEG equipment. EEG grading was performed according to Young's grading standard. The results were analyzed retrospectively by Spearman rank correlation analysis and χ2 test combined with EEG reactivity test and related clinical data. Result:①There was a negative correlation between the types of consciousness disorders such as coma, persistent vegetative state and weak state of consciousness in 106 adult patients with severe traumatic brain injury and different EEG grades (r=-0.253), and the correlation was statistically significant(P<0.05).②The outcome of consciousness disorder included improvement, no improvement, deterioration and death. It was positively correlated with different EEG grades (r=0.327), and the correlation was statistically significant (P<0.01).③The results of EEG responsiveness test and prognosis of conscious disturbance showed that the prognosis of patients with EEG responsiveness disturbance was better than that of non-responders, and the difference was statistically significant(P<0.01).④Evaluating the nature of paroxysmal events in rehabilitation therapy of consciousness disorder and continuous EEG monitoring can provide diagnostic basis. Conclusion: Continuous EEG monitoring is helpful to judge the type of consciousness disturbance, the nature of paroxysmal events and the prognosis of patients with severe traumatic brain injury, and has important clinical value.