作者：徐斌，元小冬，张萍淑，赵营，王京，欧亚

单位：

1.063000河北省唐山市，华北理工大学附属开滦总医院神经内科 2.063000河北省唐山市，河北省神经生物机能重点实验室 通信作者：张萍淑，E-mail：1977nana@sina.com

Units：

1.Department of Neurology, Kailuan General Hospital Affiliated to North China University of Science and Technology,Tangshan 063000, China 2.Hebei Key Laboratory of Neurobiological Function, Tangshan 063000, China Corresponding author: ZHANG Pingshu, E-mail: 1977nana@sina.com

关键词：

脑损伤; 定量脑电图; 脑电描记术; 脑电图; 意识障碍; 昏迷; 预测;

Keywords：

Brain injuries; Quantitative electroencephalogram; Electroencephalography; Electroencephalogram;Consciousness disorders; Coma; Forecasting

CLC：

DOI：

10.12114/j.issn.1008-5971.2022.00.097

Funds：

2020年河北省省级科技计划（第六批）项目（203777116D）；2020年度河北省医学适用技术跟踪项目（GZ2020002）；河北省2020年度医学科学研究课题计划项目（20201283）

摘要：

目的 分析定量脑电图指标(q EEG)对急性脑损伤患者意识状态的预测价值。方法 前瞻性连续收集2020年9月至2021年6月在华北理工大学附属开滦总医院神经内科重症加强治疗病房诊治的急性脑损伤患者78例为研究对象。依据格拉斯哥昏迷量表(GCS)评分,将患者分为清醒组(GCS评分为15分,25例)、意识障碍组(GCS评分为9～14分,35例)、昏迷组(GCS评分为5～8分,18例)。收集患者一般资料、qEEG监测指标〔左、右侧前额区(Fp1、Fp2)、额区(F3、F4)、中央区(C3、C4)、顶区(P3、P4)、枕区(O1、O2)、前颞区(F7、F8)、中颞区(T3、T4)、后颞区(T5、T6)的α、θ、δ、β脑波绝对功率值和各导联、全脑平均α/θ、α/(δ+θ)脑波绝对功率比值〕。采用ROC曲线分析全脑平均α/θ、α/(δ+θ)脑波绝对功率比值预测急性脑损伤患者发生意识障碍、昏迷的价值。结果 意识障碍组有高血压史者所占比例高于清醒组(P<0.05)。意识障碍组、昏迷组Fp1、Fp2、F3、F4、C4、P3、O2、F8、T3、T5、T6导联α脑波绝对功率值低于清醒组,昏迷组C3、O1、F7、T4导联α脑波绝对功率值低于清醒组(P<0.05);昏迷组Fp1导联α脑波绝对功率值低于意识障碍组(P<0.05)。意识障碍组、昏迷组Fp1、Fp2、F3、F4、C3、C4、P3、P4、O1、O2、F7、F8、T3、T4、T5、T6导联θ脑波绝对功率值高于清醒组(P<0.05);昏迷组Fp1、Fp2、F3、F4、C3、C4、P3、O1、F8导联θ脑波绝对功率值高于意识障碍组(P<0.05)。昏迷组Fp1、Fp2、F3、F4、C3、P3、F7、F8导联δ脑波绝对功率值高于清醒组(P<0.05);昏迷组Fp1、F3、C3导联δ脑波绝对功率值高于意识障碍组(P<0.05)。三组C4、P4、F8导联β脑波绝对功率值比较,差异有统计学意义(P<0.05)。意识障碍组、昏迷组Fp1、Fp2、F3、F4、C3、P3、P4、O1、O2、F7、F8、T3、T4、T5、T6导联及全脑平均α/θ、α/(δ+θ)脑波绝对功率比值和C4导联α/θ脑波绝对功率比值低于清醒组,昏迷组C4导联α/(δ+θ)脑波绝对功率比值低于清醒组(P<0.05);昏迷组F3、C4、P4导联及全脑平均α/θ脑波绝对功率比值和C4导联α/(δ+θ)脑波绝对功率比值低于意识障碍组(P<0.05)。ROC曲线分析结果显示,全脑平均α/θ、α/(δ+θ)脑波绝对功率比值预测急性脑损伤患者发生意识障碍的AUC分别为0.838〔95%CI(0.752,0.924)〕、0.825〔95%CI(0.736,0.915)〕,最佳截断值分别为1.364、0.566,灵敏度分别为73.6%、69.8%,特异度分别为88.0%、88.0%,约登指数分别为0.616、0.578,阳性似然比分别为6.132、5.818,阴性似然比分别为0.300、0.343;全脑平均α/θ、α/(δ+θ)脑波绝对功率比值预测急性脑损伤患者发生昏迷的AUC分别为0.833〔95%CI(0.741,0.926)〕、0.850〔95%CI(0.750,0.950)〕,最佳截断值分别为1.080、0.342,灵敏度分别为88.9%、83.3%,特异度分别为68.3%、81.7%,约登指数分别为0.572、0.650,阳性似然比分别为2.807、4.545,阴性似然比分别为0.163、0.204。结论 从意识障碍的发生到昏迷状态,急性脑损伤患者全脑α脑波绝对功率值减低、θ脑波绝对功率值增高以及左、右侧前额区、额区、前颞区δ脑波绝对功率值增高,且全脑平均α/θ、α/(δ+θ)脑波绝对功率比值对急性脑损伤患者发生意识障碍、昏迷有一定预测价值。

Abstract：

【Abstract】 Objective To analyze the predictive value of quantitative electroencephalogram (qEEG) indexes on thestate of consciousness in patients with acute brain injury. Methods A total of 78 patients with acute brain injury who werediagnosed and treated in the Intensive Care Unit of Department of Neurology, Kailuan General Hospital Affiliated to North ChinaUniversity of Science and Technology from September 2020 to June 2021 were prospectively and consecutively collected as theresearch objects. According to the Glasgow Coma Scale (GCS) score, the patients were divided into the awake group (GCS score of15 points, 25 cases) , the consciousness disorder group (GCS score of 9-14 points, 35 cases) , and the coma group (GCS score of 5-8points, 18 cases) . The general data and qEEG monitoring indexes [absolute power values of α, θ, δ, β brainwave of left andright frontal regions (Fp1, Fp2) , frontal regions (F3, F4) , central regions (C3, C4) , parietal regions (P3, P4) , occipital regions (O1,O2) , anterior temporal regions (F7, F8) , middle temporal regions (T3, T4) , and posterior temporal regions (T5, T6) and the ratioof absolute power values of α/θ, α/ (δ+θ) brainwave in each lead and the average ratio of absolute power values of α/θ, α/(δ+θ) brainwave of the whole brain] of the patients were collected. The ROC curve was used to analyze the value of average ratioof absolute power values of α/θ, α/ (δ+θ) brainwave of the whole brain in predicting the occurrence of consciousness disorderand coma in patients with acute brain injury. Results The proportion of patients with hypertension history in consciousnessdisorder group was higher than that in awake group (P <0.05) . The absolute power values of α brainwave of Fp1, Fp2, F3, F4,C4, P3, O2, F8, T3, T5, T6 lead in consciousness disorder group and coma group were lower than those in awake group, andabsolute power values of α brainwave of C3, O1, F7, T4 lead in coma group were lower than those in awake group (P <0.05) .The absolute power value of α brainwave of Fp1 lead in coma group was lower than that in consciousness disorder group (P <0.05) . The absolute power values of θ brainwave of Fp1, Fp2, F3, F4, C3, C4, P3, P4, O1, O2, F7, F8, T3, T4, T5, T6 lead inconsciousness disorder group and coma group were higher than those in awake group (P <0.05) . The absolute power values of θbrainwave of Fp1, Fp2, F3, F4, C3, C4, P3, O1 and F8 lead in coma group were higher than those in consciousness disorder group(P<0.05) . The absolute power values of δ brainwave of Fp1, Fp2, F3, F4, C3, P3, F7 and F8 lead in coma group were higherthan those in awake group (P <0.05) . The absolute power values of δ brainwave of Fp1, F3 and C3 lead in coma group werehigher than those in consciousness disorder group (P <0.05) . The absolute power values of δ brainwave of C4, P4 and F8 leadwere significantly different among the three groups (P <0.05) . The ratio of absolute power values of α/θ, α/ (δ+θ) brainwaveof Fp1, Fp2, F3, F4, C3, P3, P4, O1, O2, F7, F8, T3, T4, T5, T6 lead and average ratio of absolute power values of α/θ, α/(δ+θ) brainwave of the whole brain, and the ratio of absolute power values of α/θ of C4 lead in consciousness disorder groupand coma group were lower than those in awake group, and the ratio of absolute power values of α/ (δ+θ) of C4 lead in comagroup were lower than those in awake group (P <0.05) . The ratio of absolute power values of α/θ brainwave of F3, C4, P4 leadand average ratio of absolute power values of α/θ brainwave of the whole brain, the ratio of absolute power values of α/ (δ+θ)of C4 lead in coma group were lower than those in consciousness disorder group (P <0.05) . ROC curve analysis showed that theAUC of average ratio of absolute power values of α/θ, α/ (δ+θ) brainwave of the whole brain in predicting consciousnessdisorder in patients with acute brain injury were 0.838 [95%CI (0.752, 0.924) ] and 0.825 [95%CI (0.736, 0.915) ] , respectively.The best cut-off values were 1.364 and 0.566, the sensitivity was 73.6% and 69.8%, the specificity was 88.0% and 88.0%, theYouden indexes were 0.616 and 0.578, the positive likelihood ratio was 6.132 and 5.818, and the negative likelihood ratio was 0.300and 0.343, respectively. The AUC of average ratio of absolute power values of α/θ, α/ (δ+θ) brainwave of the whole brainin predicting coma in patients with acute brain injury were 0.833 [95%CI (0.741, 0.926) ] and 0.850 [95%CI (0.750, 0.950) ] ,and the best cut-off values were 1.080 and 0.342, respectively. The sensitivity was 88.9% and 83.3%, the specificity was 68.3%and 81.7%, the Youden index was 0.572 and 0.650, the positive likelihood ratio was 2.807 and 4.545, and the negative likelihoodratio was 0.163 and 0.204, respectively. Conclusion From the occurrence of consciousness disorder to coma, the absolute powervalues of α brainwave of the whole brain decreased, absolute power values of θ brainwave of the whole brain increased, and theabsolute power values of δ brainwave of left and right frontal regions, frontal regions and anterior temporal regions increased inpatients with acute brain injury, and the average ratio of absolute power values of α/θ, α/ (δ+θ) brainwave of the whole brainhave certain predictive value for consciousness disorder and coma in patients with acute brain injury.

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