失匹配负性波在昏迷患者意识水平评估中的应用价值

发布时间：2018-04-10 16:18

本文选题：失匹配负性波(MMN) + 植物状态(VS)　；参考：《昆明医科大学》2017年硕士论文

【摘要】：[目的]研究失匹配负性波(Mismatch Negativity,MMN)在昏迷患者意识水平评估中的应用价值及MMN振幅值与昏迷恢复量表(Coma Recovery Scale-Revised,CRS-R)、意识水平分级(Level of Consiciousness,LoCs)得分表在评估昏迷患者意识水平方面的相关性。[方法]选取昆明医科大学第一附属医院2015年8月至2017年1月收住急诊重症监护室(Emergency Intensive Care Unit,EICU)的昏迷患者进行前瞻性临床研究,并纳入年龄和性别与患者组匹配的17名健康人作为正常组。自患者入EICU72小时后开始每5天监测MMN、并进行CRS-R、LoCs评分,直至患者苏醒或出院,90天后电话随访,根据患者的意识水平状态,将患者分为清醒组、植物状态(Vegetative State,VS)组和最小意识状态(Minimally Conscious State,MCS)组,探讨MMN振幅值在昏迷患者意识水平评估方面的应用价值,并研究MMN振幅值与CRS-R、LoCs得分表在评估昏迷患者意识水平方面的相关性。[结果]研究结束时,共纳入15名患者数据进行研究,其中3名患者列入清醒组,8名患者列入VS组,4名患者列入MCS组。与正常组相比,VS和MCS组患者的MMN振幅值有明显的不同(P0.001);当患者从MCS逐渐转为清醒时,与正常组相比,患者的MMN振幅值就不再有明显的差异了;三个患者组组间MMN振幅值、LoCs得分、CRS-R总分值差异均有统计学意义(P0.001),进一步行LSD-t两两比较:三组间差异均有统计学意义(P0.001);MMN振幅和LoCs得分具有相关性(r=0.978,P0.001);MMN振幅和CRS-R总分值具有相关性(r=0.926,P0.001);进一步回归分析,可得到回归方程Y=0.19+2.37x(其中X=MMN振幅值,Y=LoCs得分值);绘制MMN振幅值的ROC曲线,分析得到:清醒组ROC曲线下面积等于0.93,以3.22μV为最佳临界值,预测清醒的灵敏度为94%,特异度为95%;MCS组ROC曲线下面积等于0.96,以2.23μV为最佳临界值,预测MCS的灵敏度为98%,特异度为99%;VS组ROC曲线下面积等于0.94,以1.21μV为最佳临界值,预测VS的灵敏度为96%,特异度为97%。[结论]1、随着MMN振幅值的逐渐增大,昏迷患者意识水平逐渐好转;2、MMN振幅值与LoCs得分和CRS-R总分值在评估昏迷患者意识水平方面具有相关性,可以作为一个客观指标评估昏迷患者的意识水平。
[Abstract]:[objective] to study the application value of mismatched negative wave mismatch Negativityn (MMNs) in evaluating consciousness level of coma patients and the correlation between MMN amplitude and coma recovery scale (Coma Recovery Scale-Revisedger CRS-RN, level of consciousness level of Consiciousnessy LoCs) in evaluating consciousness level of coma patients.[methods] A prospective clinical study was conducted among the coma patients admitted to the Emergency Intensive Care EICU in the first affiliated Hospital of Kunming Medical University from August 2015 to January 2017.17 healthy persons matched with age and gender were included as normal group.MMNs were monitored every 5 days after the patients were admitted to EICU72, and the CRS-RN LoCs scores were scored. The patients were followed up by telephone 90 days after the patients woke up or discharged from the hospital. According to the consciousness level of the patients, the patients were divided into conscious group.To explore the value of MMN amplitude in evaluating consciousness level of coma patients, and to study the correlation between MMN amplitude value and CRS-RnLoCs score table in evaluating consciousness level of coma patients.[results] at the end of the study, a total of 15 patients were included in the study, of which 3 patients were included in the awake group, 8 patients were included in the vs group and 4 patients were included in the MCS group.Compared with the normal group, the MMN amplitudes of the patients with vs and MCS were significantly different from those of the normal group (P 0.001), and when the patients gradually changed from MCS to sober, there was no significant difference in the amplitude of MMN between the patients and the normal group.There were significant differences in MMN amplitudes and CRS-R scores among the three groups. Further comparison of LSD-t was made between the three groups. There was a significant correlation between the amplitude of LSD-t and the LoCs score. There was a correlation between the amplitudes of LoCs and the amplitude of LSD-t and the total score of CRS-R.R = 0.926 (P 0.001); further regression analysis,The regression equation Y ~ (0.19) 2.37 x (where the X=MMN amplitude is 0.19 2.37 x) and the ROC curve of MMN amplitude are drawn. The area under the ROC curve is 0.93, and 3.22 渭 V is the best critical value.The sensitivity of MCS prediction was 940.The area under the ROC curve of 95g MCS group was equal to 0.96.The optimum critical value was 2.23 渭 V, the sensitivity of predicting MCS was 98, the area under the ROC curve of 99v group was 0.94, and 1.21 渭 V was the best critical value.The sensitivity of predicting vs was 96 and the specificity was 97.[conclusion] 1. With the increasing of MMN amplitude, the consciousness level of coma patients improved gradually, and the LoCs score and the total CRS-R score were correlated with the consciousness level of coma patients.It can be used as an objective index to evaluate the consciousness level of coma patients.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R459.7

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