脑电图相对波段功率在急性脑梗死的临床应用研究

发布时间：2018-06-01 09:17

本文选题：脑梗死 + 大面积脑梗死　；参考：《第二军医大学》2013年硕士论文

【摘要】：[目的]：本研究通过观察急性颈内动脉系统大面积脑梗死与局灶性脑梗死在头颅CT未显影阶段脑电图相对波段功率的分布差异以及动态监测急性大面积大脑中动脉供血区梗死起病后不同时间段的的相对波段功率变化趋势,旨在探讨脑电图相对波段功率在急性颈内动脉系统缺血性脑卒中的早期诊断价值及重症卒中预后评估方面的临床应用价值。通过本研究为卒中单元的神经监护模式发展提供一种客观、直观、易于床边监测的脑功能监测方法。 [方法]：本研究的研究组分为早期诊断组、动态趋势变化组,两组分别设置对照组。早期诊断组：该研究组共计纳入急性颈内动脉系统脑梗死患者38例(局灶性脑梗死20例,大面积脑梗死18例),EEG正常的同期住院患者30例(对照组)。对研究组患者及招募的对照组患者分别采取8通道中央导联的记录模式进行常规EEG及RBP趋势图监测,研究组保证发病24内完成床边EEG检查,每次至少监测30分钟。观察梗死部位脑区与对侧脑区、梗死侧枕部脑区与健侧枕部脑区的RBP变化并对比分析。比较局灶性脑梗死、大面积脑梗死、正常对照组的RBP差异。动态趋势变化组：本研究组共计纳入急性大脑中动脉供血区大面积脑梗死患者30例,同期住院患者30例(对照组)。对研究组患者分别在发病后48小时内、第5-6天、第10-11天进行床旁EEG监测,记录患者的一般资料、并发症及实验室检查结果。对照组患者相应在入院后48小时内、第5-6天、第10-11天进行床旁EEG监测。在起病1个月时进行临床随访观察,根据是否存活,分为存活组及死亡组,回顾性分析两组脑梗死患者在发病后48小时内、第5-6天、第10-11天三个阶段时的脑电图RBP动态变化趋势,进一步比较存活组、死亡组、对照组间RBP趋势变化的差异。 [结果]：第一部分：梗死部位脑区与对侧脑区比较：局灶性梗死组在各波段RBP上均表现为不对称性,病灶部位脑区δ波、θ波RBP较对侧显著增大(P0.01),α波、β波的RBP显著减低(P0.01)；大面积梗死组RBP的分布亦存在不对称性,患侧脑区δ波RBP较对侧显著增大(P0.01),α波、β波的RBP显著减低(P0.01),但θ波RBP双侧对比无明显统计学差别(P0.05)。与对照组比较,两组脑梗死患者梗死脑区均表现为δ波、θ波RBP增大(P0.01),α波、β波的RBP减低(P0.01)。枕部RBP变化：两组不同面积脑梗死患者,双侧枕部各波段RBP上均表现为不对称性,梗死侧枕部较健侧枕部δ波、θ波RBP值增大,α波、β波的RBP降低(P0.05)；健侧枕部RBP与对照组比较,大面积组表现为δ波、θ波RBP增大,α波、β波的RBP降低(P0.05),局灶性组中,除θ波RBP轻微增高外,δ波、α波、β波RBP均无统计学差异(P0.05)。第二部分： 1、梗死脑区RBP于48h内、5-6天、10-11天三阶段趋势变化。死亡组、存活组患者住院期间梗死脑区δ、0、α、β波段的RBP值均有随时间变化的趋势,并且两组变化趋势存在差异(P0.05),而对照组四个波段的RBP值三次监测中未发现明显变化(P0.05)；两组脑梗死患者的梗死脑区6、θ波RBP值三个时间段均显著高于对照组,α、β波RBP值均显著低于对照组(P0.05)。两组脑梗死患者住院时梗死部位脑区的δ、θ、α、β波RBP值无明显差异(P0.05)。死亡组的δ波段RBP值三次监测中表现为持续上升趋势；存活组表现为先上升、后下降的趋势,10天时仅略高于入院时水平；5-6天时死亡组δ波RBP值上升的幅度远高于存活组。死亡组的梗死部位脑区θ波段RBP值三次监测中表现为持续下降趋势；存活组表现为先下降,中后期监测无明显变化；中期监测结果两组无明显差异。死亡组的梗死部位脑区α波段RBP值三次监测中表现为持续下降趋势；存活组α波段RBP值在1周内基本维持在入院时水平,此后逐渐升高,但10天时仍未恢复至正常水平；死亡组α波段RBP值整体趋势显著低于存活组。死亡组β波RBP值住院期间表现为先下降,再轻度回升的趋势,10天时仍低于入院时水平；存活组β波RBP值1周内基本维持在入院时水平,此后有逐渐升高趋势;死亡组β波段RBP值整体趋势显著低于存活组。 2、病灶对侧脑区RBP于48h内、5-6天、10-11天三阶段趋势变化死亡组、存活组患者住院期间梗死对侧脑区δ、θ、α、β波段的RBP值均有随时间变化的趋势,并且两组变化趋势存在明显统计学差异(P0.05),而对照组四个波段的RBP值三次监测中未发现明显变化(P0.05)；两组脑梗死患者的梗死对侧脑区δ、0波RBP值三个时间段均显著高于对照组,α、β波RBP值均显著低于对照组(P0.05)。死亡组梗死灶对侧脑区δ波RBP值入院期间表现为逐渐上升趋势；存活组病灶对侧脑区δ波RBP值在6天内逐渐升高,此后逐渐下降,10天时基本恢复至入院时水平；存活组病灶对侧脑区6波RBP值的整体趋势远低于死亡组,三次监测中差值有逐渐增大的趋势。死亡组梗死灶对侧脑区0波RBP值三次监测中表现为逐渐下降趋势；存活组,梗死灶对侧脑区的0波段RBP变化趋势为6天内逐渐下降,后两次监测结果无明显差异;死亡组病灶对侧脑区e波RBP值的整体趋势远低于存活组。死亡组梗死灶对侧脑区α波RBP值的变化趋势为先下降,6-10天基本维持在较低水平不变；存活组梗死对侧脑区α波的变化趋势为先逐渐下降,尔后逐渐上升,10-11天基本恢复到入院时水平；死亡组病灶对侧脑区α波RBP值的整体趋势远低于存活组。死亡组病灶对侧脑区β波RBP值变化趋势为,5-6天逐渐下降到较低值,10-11天时略有回升,但仍低于入院时检测值；存活组,住院期间先呈下降趋势,此后逐渐升高,第三次监测结果已高于入院时水平；两组入院时处于相同水平,此后的下降趋势中死亡组的下降幅度远大于存活组,降低至较低水平,10-11天时仍未有大幅度回升。 3、梗死脑区与对侧脑区趋势变化的配对比较死亡组与存活组患者住院期间双侧脑区的α、β、0、δ波段的RBP值均有随测量时间段变化的趋势；死亡组的四个波段在双侧脑区的变化趋势均具有不一致性；存活组6、α、β波段双侧脑区的变化趋势具有不一致性,0波段的变化趋势还不能认为双侧存在统计学差异。两组患者住院期间四个波段双侧脑区的分布水平均呈现不对称性,梗死脑区的α、β波RBP值三个时间段均显著低于对侧脑区,δ波RBP值均显著高于对侧脑区,死亡组α波的双侧不对称性有逐渐增大的趋势；死亡组患者入院时梗死脑区θ波段RBP值高于对侧,此后两次监测双侧脑区的0波段RBP值均呈下降趋势,梗死脑区的下降幅度远大于对侧,中后期监测时,梗死脑区显著低于对侧脑区；存活组入院时双侧脑区0波段基本对称,此后渐呈现出不对称性,中后期监测时,梗死侧脑区的0波段RBP值均显著低于对侧。 [结论]：1、脑电图RBP对于CT尚未显影阶段的急性颈内动脉系统脑梗死具有早期定侧意义,结合枕部的RBP变化,可初步鉴别大面积脑梗死。2、急性大面积大脑中动脉供血区梗死患者梗死脑区、对侧脑区的α、β、θ、δ波段RBP值住院期间均有随监测时间段变化的趋势,1个月时存活患者与死亡患者住院期间各波段RBP变化趋势均呈现明显的差异性。重症半球梗死患者住院期间RBP变化趋势的动态监测可及时反映其脑功能变化,对于评估病情及一个月时的生存机会具有重要价值。
[Abstract]:[Objective] to observe the distribution difference of the relative band power of the acute cerebral infarction and focal cerebral infarction in the undeveloped CT stage of the acute internal carotid artery system and the dynamic monitoring of the change trend of the relative band power in the acute large area of the acute large area of the middle cerebral artery supply area after the infarction. The clinical value of the EEG relative band power in the early diagnosis of the acute internal carotid artery system ischemic stroke and the evaluation of the prognosis of severe stroke. This study provides an objective, intuitive, and easy to monitor method of brain function monitoring for the development of the neural monitoring model for stroke unit.
[method] the research group of this study was divided into early diagnosis group, dynamic trend change group, and the two groups were set up control group respectively.
Early diagnosis group: the study group included 38 patients with acute internal carotid artery system cerebral infarction (20 cases of focal cerebral infarction, 18 cases of large area cerebral infarction), 30 cases of normal EEG hospitalized patients (control group). In the study group and the recruited control group, the 8 channel central lead recording mode was adopted for routine EEG and RBP chemotaxis. The study group ensured that the bedside EEG examination was completed within 24 of the onset of the disease for at least 30 minutes each time. The changes in the cerebral area of the infarct site and the contralateral brain region, the occipital cerebral area of the infarct side and the lateral occipital region of the healthy side were compared and analyzed. The differences in the RBP difference between the focal cerebral infarction, the large area cerebral infarction and the normal control group were compared.
Dynamic trend change group: 30 cases of acute cerebral infarction in the middle cerebral artery blood supply area were included in this study group, and 30 patients in the same period were hospitalized (control group). The patients in the study group were monitored by bedside EEG within 48 hours, 5-6 days, and 10-11 days after the onset of the disease, and the general data, complications and laboratory results were recorded. After 48 hours of admission, 48 hours, 5-6 days and 10-11 days after admission, the patients were followed up for 1 months. According to the survival, the patients were divided into the survival group and the death group. The dynamic changes of the electroencephalogram (RBP) of the two groups of cerebral infarction patients in 48 hours after the onset, the 5-6 day, and the three stage 10-11 days at the 10-11 day were analyzed. Trends were further compared between the survival group, the death group and the control group with the difference in the trend of RBP.
[results]:
Part one:
Compared with the contralateral brain area, the infarct area was asymmetrical on the RBP of the focal infarction group, the delta wave in the brain region of the lesion and the RBP of the theta wave were significantly increased (P0.01), the RBP of the alpha wave and the beta wave decreased significantly (P0.01). The distribution of RBP in the large area infarction group was also asymmetrical, and the delta wave RBP was significantly increased (P0) in the affected side of the cerebral area (P0). .01), the RBP of the alpha wave and beta wave decreased significantly (P0.01), but there was no significant difference between the two sides of theta wave RBP (P0.05). Compared with the control group, the infarct brain regions of the two groups of cerebral infarction were all delta wave, theta RBP increase (P0.01), alpha wave, RBP reduction (P0.01) of beta wave, and the change of occipital RBP: two groups of different area cerebral infarction patients, bilateral occipital bands RBP on each band Compared with the healthy lateral occipital region, the RBP value of the lateral occipital lobe was increased, the RBP of the alpha wave and the beta wave decreased (P0.05). Compared with the control group, the lateral occipital RBP in the healthy side showed delta wave, theta wave RBP increased, the RBP decreased (P0.05) in the alpha wave and beta wave, and there was no statistical difference between the delta wave, the alpha wave and the beta wave RBP in the focal group. Differences (P0.05).
The second part:
1, the infarct area RBP changes in 48h, 5-6 days, 10-11 days and three stages.
In the death group, the RBP values in the infarct brain region of the patients in the survival group were changed with time, and the change trend of the two groups was different (P0.05), while the RBP value of the four bands in the control group was not significantly changed in the three time monitoring (P0.05); the two group of cerebral infarction patients had 6 and three RBP values of theta wave, three time Duan Junxian. The RBP values of alpha and beta waves were significantly lower than those in the control group (P0.05). There was no significant difference in the value of delta, theta, alpha and beta wave RBP in the cerebral infarction area of the two groups of cerebral infarction (P0.05). The RBP value in the delta band of the dead group showed a continuous upward trend in the three monitoring of the delta band RBP value; the survival group showed a rising, then declining trend, only slightly higher than the 10 day. At the time of admission, the increase in the RBP value of the delta wave in the death group was much higher than that in the survival group at 5-6 days. The RBP value of the cerebral area in the infarct area of the dead group showed a continuous downward trend in the three monitoring. The survival group was first descended, and the middle and late monitoring had no obvious changes; there was no significant difference in the middle and late monitoring results between the two groups. The alpha band RBP value of the region showed a continuous downward trend in the three time monitoring. The RBP value of the alpha band in the survival group was basically maintained at the admission level within 1 weeks, and then gradually increased, but still did not recover to the normal level at 10 days. The overall trend of the RBP value in the alpha band of the death group was significantly lower than that in the survival group. The RBP value of the death group was first decreased during the period of hospitalization. The trend of mild recovery was still lower than the level of admission at 10 days. The RBP value of the survival group was basically maintained at the admission level in 1 weeks, and then the trend was gradually rising, and the overall trend of the RBP value in the beta band of the death group was significantly lower than that in the survival group.
2, the changes of RBP in 48h, 5-6 days, 10-11 days and three stages in the contralateral brain area.
In the death group, the RBP values of the infarct contralateral brain region in the infarct contralateral brain were changed with time, and there was a significant statistical difference between the two groups (P0.05), while the RBP values in the four bands of the control group were not significantly altered in the three time monitoring (P0.05), and the infarct to lateral brain area of the two cerebral infarction patients was Delta, 0 wave. The value of RBP in three time periods was significantly higher than that in the control group, and the RBP value of alpha and beta wave was significantly lower than that of the control group (P0.05). The delta wave RBP value of the infarct area in the death group was gradually rising, and the RBP value of the Delta wave in the lateral brain area of the survival group gradually increased in 6 days, and then gradually descended at 10 days, and then basically recovered to the level of admission. The overall trend of the 6 wave RBP value in the lateral brain region of the live group was much lower than that in the death group. The difference in the three monitoring was gradually increasing. The 0 wave RBP value of the 0 wave in the lateral brain area of the death group was gradually decreasing; the survival group, the 0 band RBP of the infarct to the lateral brain area was gradually decreased in 6 days, and the last two monitoring results were found. There was no significant difference. The overall trend of the E wave RBP value in the lateral brain area of the death group was much lower than that in the survival group. The change trend of the RBP value of the alpha wave in the lateral brain area of the death group was first decreased, and the 6-10 day was basically maintained at the lower level. The change trend of the alpha wave in the lateral brain area of the survival group was gradually decreased, then the 10-11 day was gradually rising, and the basic level of the infarction in the lateral brain area was gradually increased. The overall trend of the alpha wave RBP value in the lateral brain area of the death group was much lower than that in the survival group. The trend of the RBP value of the beta wave in the lateral brain area of the death group was gradually decreased to the lower value in the 5-6 day, but it was slightly lower at the 10-11 day, but still lower than the admission test value. The results of the third monitoring were higher than the level of admission. The two groups were at the same level when they were admitted to the hospital. The decline of the death group was much larger than that of the survival group, which was lower to the lower level, and there was still no significant recovery at 10-11 days.
3, paired comparisons of infarcted brain areas and contralateral brain regions.
The RBP values in the bilateral brain regions of both the death group and the survival group had a tendency to change with the measured time period, and the changes in the four bands of the death group were inconsistent in the bilateral brain regions; the survival group was 6, the changes of the bilateral brain regions in the alpha and beta bands were inconsistent, and the change trend in the 0 band was not yet possible. There was a statistical difference between the two sides of the two groups. The levels of bilateral brain regions in the four bands of the two groups were asymmetrical. The three periods of alpha and beta wave in the infarct brain region were significantly lower than those in the contralateral brain, and the RBP value of the delta wave was significantly higher than that in the contralateral brain, and the bilateral asymmetry of the alpha wave in the death group was gradually increased. At the time of admission, the RBP value of the infarct brain area was higher than the contralateral side, and the 0 band RBP values of the bilateral brain regions were decreased in two times. The decrease in infarct brain area was much larger than that in the contralateral side. The infarct brain area was significantly lower than that in the contralateral brain area in the middle and late stage. The 0 band of bilateral brain area in the survival group was basically symmetrical when the survival group was hospitalized. In the middle and later stages of monitoring, the 0 band RBP values in the infarcted side were significantly lower than those in the contralateral side.
[conclusion]:1, electroencephalogram RBP has the early side significance for acute cerebral infarction in the acute internal carotid artery system of CT, and combined with the changes of RBP in the occipital region, it can identify the large area cerebral infarction.2, acute large area cerebral artery blood supply area infarcted brain area, and the alpha, beta, theta and delta RBP values in the lateral brain area are monitored during the hospitalization. The trend of the change of the time segment of the patient was significantly different in the RBP changes during the 1 months of hospitalization. The dynamic monitoring of the RBP trend in patients with severe hemispheric infarction can reflect the changes in the brain function in time, which is of great value for assessing the condition and the chance of survival at one month.
【学位授予单位】：第二军医大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R542.22

【共引文献】