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目的探讨脑电双频指数监测在评估重型颅脑损伤患者预后的临床应用。方法共纳入郑州大学人民医院2014年1月至2014年12月间急诊ICU收治的52例重型颅脑损伤患者。均在入院后24h内的相同时间点开始行BIS监测1h,自入院监测BIS值5~7d,后对出院或转普通病房者进行定期随访。记录患者预后,包括死亡、植物状态(意识未恢复,但各种反射及自主呼吸良好)、致残(意识恢复,但留有后遗症,如智力障碍、语言障碍或肢体活动障碍等)、康复。分析BIS值与GCS评分的相关性。同时根据患者的BIS值,记录每个患者的预后情况,分析BIS值和预后的关系。根据预后分为三组:死亡组,意识未恢复组,意识恢复组,对比组间的BIS值,分析BIS值对重型颅脑损伤患者预后判定的敏感度和特异度。结果 BIS值与GCS评分呈正相关。52例患者中,死亡18例,植物状态15例,致残12例,康复7例。随着BIS值的升高,死亡及植物状态率逐渐降低,意识恢复率逐渐升高。结论 BIS监测在评估重型颅脑损伤患者预后方面具有重要价值。
Objective To investigate the clinical application of bispectral index monitoring in evaluating the prognosis of patients with severe craniocerebral injury. Methods Fifty-two patients with severe craniocerebral injury admitted to Emergency ICU from January 2014 to December 2014 in People’s Hospital of Zhengzhou University were recruited. BIS monitoring was performed for 1 hour at the same time point within 24 hours after admission, and the BIS value was 5 to 7 days after hospital admission. Periodical follow-up was performed on those discharged or transferred to general wards. Patients were recorded for prognosis, including death, vegetative state (unconsciousness but good reflexes and spontaneous breathing), disability (recovery of consciousness but with sequelae such as mental retardation, speech impairment or limb movement disorder, etc.) and rehabilitation. Analyze the correlation between BIS value and GCS score. At the same time, the prognosis of each patient was recorded according to the BIS value of the patient, and the relationship between the BIS value and the prognosis was analyzed. According to the prognosis, the patients were divided into three groups: the death group, the unconscious group, the conscious recovery group and the control group. The sensitivity and specificity of the BIS value in predicting the prognosis of patients with severe craniocerebral injury were analyzed. Results The BIS value was positively correlated with GCS score. Of the 52 patients, 18 died, 15 were in vegetative state, 12 were disabled, and 7 were recovered. With the increase of BIS value, the rate of death and plant status gradually decreased, and the rate of recovery of consciousness gradually increased. Conclusion BIS monitoring is of great value in assessing the prognosis of patients with severe craniocerebral injury.