目的 探讨体感诱发电位(SEPs)联合事件相关电位(ERPs)预测昏迷患者预后的临床应用价值.方法 从201 1年1月至2014年6月首都医科大学宣武医院神经内科重症监护病房收治的神经重症患者中,纳入53例昏迷患者进行前瞻性队列研究;发病7d内行短潜伏期体感诱发电位(SLSEP)、中潜伏期体感诱发电位(MLSEP)和ERPs[N100、失匹配负波(MMN)]检测;病后3个月行预后追踪,格拉斯哥预后量表(GOS)评分3～5分为预后良好,GOS评分1～2分为预后不良.同时纳入健康对照者30名,同样进行SLSEP、MLSEP和N100、MMN检测.结果 昏迷患者与健康对照者比较,N20、N60、N100、MMN振幅降低、潜伏期延长;预后不良患者N20、N60、N100、MMN潜伏期(ms)分别为21.73±2.91、68.67±7.60、114.81±21.60、194.10±55.31,预后良好患者N20、N60、N100、MMN潜伏期(ms)分别为20.74±2.05、64.20±5.29、109.74±21.30、181.00±50.32;预后良好组与预后不良组比较,SLSEP的N20、MLSEP的N60、ERPs的N100和MMN的存在与消失差异有统计学意义(x2值分别为14.60、10.59、14.46和18.12,均P＜0.05).SEPs联合ERPs预测良好预后的敏感度为85.2％,特异度为74.2％,总正确率为86.8％;预测不良预后敏感度为74.2％,特异度为85.2％,总正确率为86.8％.结论 双侧N20消失是预测昏迷患者不良预后的可靠指标,双侧N60、N100及MMN存在是预测昏迷患者良好预后的指标.当联合SEPs与ERPs后,预测良好预后与不良预后更加完整准确.%Objective To explore the effectiveness of using somatosensory evoked potentials (SEPs) combined with event-related potentials (ERPs) to predict the prognosis of comatose patients in neurologic intensive care units (N-ICU).Methods A prospective cohort study was conducted in 53 comatose patients enrolled from the Department of Neurology,Xuanwu Hospital of Capital Medical University from January 2011 to June 2014.Short-latency somatosensory evoked potentials (SLSEP),middle-latency somatosensory evoked potentials (MLSEP),N100,and mismatch negative (MMN) were recorded in these comatose patients in N-ICU within one week after coma onset.All patients were evaluated with Glasgow Outcome Scale (GOS) in 3 months after onset.GOS grades 3 to 5 were considered the good outcome; while GOS grades 1 and 2 were considered poor.SLSEP,MLSEP,N100 and MMN were also recorded in 30 healthy controls.The consistency between SLSEP,MLSEP,N100,MMN,and prognosis,as well as the prognostic authenticity of SLSEP,MLSEP,N100 and MMN were analyzed.Results The amplitude was smaller and the latency became longer in comatose patients,compared with healthy controls.The latency of N20,N60,N100 and MMN in patients with good outcome was (21.73 ±2.91) ms,(68.67 ±7.60) ms,(114.81 ±21.60) ms and (194.10 ±55.31) ms,respectively.And the latency of N20,N60,N100 and MMN in patients with poor outcome was (20.74 ±2.05) ms,(64.20 ±5.29) ms,(109.74 ±21.30) ms and (181.00 ± 50.32) ms,respectively.The consistency between poor outcome and absence of evoked potentials for N20,N60,N100 and MMN was satisfactory (x2 =14.60,10.59,14.46,18.12 respectively,all P ＜ 0.05).When combined SEPs with ERPs,the sensitivity was 85.2％,specificity was 74.2％,and general correct rate was 86.8％,respectively,for good outcome; the sensitivity was 74.2％,specificity was 85.2％,and general correct rate was 86.8％,respectively,for poor outcome.Conclusions The bilateral absence of N20 has a good power for predicting the poor outcome in comatose patients,while the bilateral existence of N60,N100 and MMN has a good power for predicting the good outcome.The combined use of SEPs and ERPs in evaluating and predicting the outcomes in comatose patients is suggested.
展开▼
