脑状态指数在颅脑外伤患者意识状态监护中的应用价值

摘要

Objective To investigate the value of cerebral state index (CSI) in monitoring the consciousness state of patients with brain trauma.Methods The consciousness sates of 218 patients with craniocerebral trauma were assessed by three experienced specialists by Glasgow Coma Scale (GCS),and the CSI of the patients were measured by Cerebral State Monitor.Correlation between GCS and CSI as well as the distribution of CSI in various consciousness defined by GCS were discussed.The predictive value of CSI in discriminating different conscious states of the patients was also analyzed.Results The Cochran Q test showed that there was a consistency of the GCS judged by three specialists (P ＞ 0.05),and the CSI of the patients was positively correlated with the GCS (r=0.819,P＜0.001).A gradual decrease in the CSI was found across categories of the various consciousness states,including sobriety,somnolence,confusion,light coma,coma in moderate depth and deep coma.The receiver operating characteristic curve (ROC) analysis showed that CSI could significantly discriminate the different consciousness states of the patients (P ＜0.001).The area under the curve (AUC) for the consciousness was 0.995 for deep coma,0.984 for sobriety,0.815 for coma in moderate depth,0.769 for somnolence,0.768 for light coma and 0.695 for confusion,respectively.Conclusion CSI can be used to monitor the severity of craniocerebral trauma.%目的 评价脑状态指数(CSI)在量化颅脑外伤患者意识障碍中的应用价值.方法 3名专科医生分别对218例颅脑外伤患者的意识状态进行格拉斯哥昏迷评分(GCS),并以脑状态监测仪检测其CSI值.观察GCS与CSI的相关性.以GCS人工评估结果为标准,调查各种意识状态的CSI分布区间,评价以CSI数值判定意识状态的准确性.结果 3名专科医师GCS评分一致性良好(P＞0.05).GCS水平与CSI值呈正相关(r=0.819,P＜0.001).意识状态从清醒、嗜睡、模糊、浅昏迷、昏迷至深昏迷,CSI呈线性降低趋势.ROC分析显示CSI对各种意识状态判定均有统计学意义(P ＜0.001).判定效率采用ROC曲线下面积表示,从高到低依次为深昏迷、清醒、昏迷、嗜睡、浅昏迷和模糊.结论 CSI可准确、实时、客观地监测脑功能损害程度.