体感诱发电位和脑干听觉诱发电位预测恢复期严重意识障碍患儿意识恢复的价值

摘要

Objectives To explore the dynamic changes of somatosensory evoked potential (SEP) and brainstem auditory evoked potential (BAEP) in children with severe disturbance of consciousness during recovery, and their predictive values for conscious recovery.Methods Fifty-two patients with severe disturbance of consciousness hospitalized during July 2013 to June 2014 were included. Clinical assessment and assessments of SEP and BAEP were ifnished within 48 h after admission. In the course of 12 months, coming out of minimum state of consciousness or death were the end point for assessment.Results Within one year, there were 27 cases recovered their consciousness among these 52 cases and consciousness recovery rate was 51.2%. No differences in the recovery rate of consciousness in various pathogenesis (P>0.05). There were 24 cases with stage I in SEP grade on the ifrst time, in which 20 cases recovered consciousness and 4 cases did not recover after one year hospitalization (3 cases remain stage I after reexamination and one case progressed to stage III). There were 28 cases with stage II or stage III in SEP grade on the ifrst time; 3 cases turn stage II to stage I, inwhich 2 cases recovered their consciousness; 2 cases turn stage III to stage I, in which one case fully recovered with consciousness. The other 23 cases remained in stage II or stage III and only 3 patients completely recovered in the one year course. Among 52 cases, 50 cases had normal BAEP, and one case had stage II and one case had stage I.Conclusions SEP can be used to predict consciousness recovery during recovery phase in children with severe disturbance of consciousness. However, BAEP cannot.%目的：探讨恢复期严重意识障碍患儿体感诱发电位(SEP)、脑干听觉诱发电位(BAEP)动态变化特点，及其对患儿意识恢复的预测价值。方法2013年7月－2014年6月住院治疗的脑损伤恢复期严重意识障碍患儿52例，入住康复科48 h内完成临床评估和SEP、BAEP评估，病程满12个月、脱离最低意识状态、死亡为评估止点。结果52例患儿在病程1年内有27例恢复意识，意识恢复率为51.2%，各种病因所致的严重意识障碍患儿的意识恢复率差异无统计学意义（P＞0.05）。首次SEP检查分级越高，意识恢复率越低（P＜0.001）；首次SEP检查分级为Ⅰ级的患儿24例，其中20例意识恢复，有4例（3例多次复查SEP均为1级，1例转为3级）在病程1年时其意识仍未恢复。首次SEP检查为Ⅱ级或Ⅲ级的患儿28例，有3例患儿由Ⅱ级转为Ⅰ级，其中2例意识完全恢复，有2例患儿由Ⅲ级转为Ⅰ级，其中有1例意识完全恢复。其余23例持续为Ⅱ级或Ⅲ级，在病程1年时最终只有3例意识完全恢复。52例患儿中有50例BAEP检查正常，Ⅱ级、Ⅲ级各1例。结论 SEP可以作为恢复期严重意识障碍患儿意识是否恢复的有效预测指标。BAEP对于处于恢复期的严重意识障碍患儿的意识是否恢复缺乏预测性。