黄煌?李幼霞?杜淑华?邓西龙

【摘要】目的 探討振幅整合脑电图（aEEG）评估高血压脑出血合并脑疝患者临床预后及脑功能的临床价值。方法 对26例合并脑疝的高血压脑出血患者术后的临床资料进行回顾性分析。记录患者的一般临床资料、急性生理学与慢性健康状况评分系统Ⅱ（APACHE Ⅱ）评分、格拉斯哥昏迷评分（GCS）及术后6 h 内aEEG数据。主要临床结局为患者离开ICU病房时的状态及转出ICU后1个月的脑功能预后[格拉斯哥-匹兹堡脑功能评分（CPC）]。用Spearman 秩相关分析aEEG与GCS、APACHE Ⅱ评分之间及其与临床预后及脑功能预后的相关性。结果 26例患者中男23例、女3例，年龄（59.4±8.61）岁;术前GCS 3分 7例，4 ～ 8分16例，9 ～ 15分3例;APACHE Ⅱ评分<15分11例，16 ～ 30分11例，>31分4例;aEEG正常（Ⅰ级）5例，中度异常（Ⅱ级）10例，重度异常（Ⅲ级）11例;存活18例，死亡8例，存活患者中脑功能预后良好（CPC 1 ～ 2分）6例，脑功能预后不良（CPC 3 ～ 4分）12例。存活组及死亡组术前APACHE Ⅱ评分比较差异无统计学意义（P > 0.05），而aEEG分级和术前GCS级别比较差异有统计学意义（P均< 0.05）。脑功能预后良好组及预后不良组术前APACHE Ⅱ评分级别与GCS比较差异无统计学意义（P均> 0.05），而aEEG分级比较差异有统计学意义（P < 0.05）。结论 aEEG技术可以较准确地反映合并脑疝的高血压脑出血患者术后脑功能情况，对预测临床预后及评价脑功能具有重要的现实价值和临床意义。

【关键词】高血压脑出血;脑疝;振幅整合脑电图;脑功能;预后

Evaluation of postoperative brain function and clinical prognosis of patients with hypertensive cerebral hemorrhage complicated with cerebral hernia by amplitude-integrated electroencephalogram Huang Huang， Li Youxia， Du Shuhua， Deng Xilong. Department of Critical Care Medicine， Guangzhou Eighth Peoples Hospital， Guangzhou Medical University， Guangzhou 510060， China

Corresponding author， Deng Xilong， E-mail： gz8hdxl@ 126. com

【Abstract】Objective To evaluate the clinical value of amplitude-integrated electroencephalogram （aEEG） in evaluating clinical prognosis and brain function of patients with hypertensive cerebral hemorrhage complicated with cerebral hernia. Methods Clinical data of 26 patients with postoperative hypertensive cerebral hemorrhage complicated with cerebral hernia were retrospectively analyzed. Baseline clinical data， acute physiology and chronic health evaluation systemⅡ（APACHE Ⅱ） score， Glasgow coma scale （GCS） and aEEG data within postoperative 6 h were recorded. The patients status at the time of transfer from ICU and clinical prognosis of brain function at 1 month after transfer from ICU （（Glasgow-Pittsburgh brain function score （CPC）） were regarded as the main clinical outcomes. Spearman rank correlation was used to analyze the relationship among aEEG，GCS， APACHEⅡand their correlation with clinical prognosis and brain function prognosis. Results Among 26 patients， 23 cases were male and 3 female， aged （59.4±8.61） years on average. Seven patients obtained preoperative Glasgow score of 3， 16 cases of 4-8 and 3 cases of 9-15. Eleven patients had APACHEⅡscore of <15， 11 cases of 16-30 and 4 cases of > 31. Five patients had normal aEEG （Grade I）， 10 cases of moderately abnormal aEEG （Grade Ⅱ） and 11 cases of severely abnormal aEEG （Grade Ⅲ）. A total of 18 cases survived and 8 died. Among 18 surviving patients， the prognosis of brain function was good （CPC score of 1-2） in 6 patients， and poor prognosis of brain function （CPC sore of 3-4 score） was observed in 12 cases. Preoperative APACHEⅡ score did not significantly differ between the survival and death groups （P > 0.05）， whereas the aEEG grade and preoperative GCS score significantly differed between two groups （both P < 0.05）. Preoperative APACHEⅡ and GCS scores did not significantly differ between the good and poor prognosis of brain function groups （both P > 0.05）， whereas the aEEG grade significantly differed between two groups （P < 0.05）. Conclusion aEEG technique can accurately reflect the postoperative brain function of patients with hypertensive cerebral hemorrhage complicated with cerebral hernia， which has important practical and clinical significance in predicting clinical prognosis and brain function prognosis.

【Key words】Hypertensive cerebral hemorrhage;Cerebral hernia;

Amplitude-integrated electroencephalogram;Brain function;Prognosis

高血压脑出血是常见的脑血管疾病，好发于中老年人，发病突然、进展迅速、病情凶险，一旦发生脑疝，即使及时手术，仍有极高的病死率、致残率，相当部分患者最终可能发展为植物状态，给家庭造成了沉重的心理和经济负担[1]。因此精确评估此类患者的脑功能及预后具有重要的现实价值和临床意义。目前有学者认为振幅整合脑电图（aEEG）技术可以较准确地反映患者脑功能的保留程度，对预测不同类型昏迷患者的预后具有一定价值[2-4]。本研……