振幅整合脑电图对神经内科意识障碍患者近期预后的预测价值

发布时间：2018-05-30 10:19

本文选题：振幅整合脑电图 + 急性生理-慢性健康状态评分　；参考：《重庆医科大学》2014年硕士论文

【摘要】：目的：应用aEEG对神经内科监护室意识障碍患者进行脑电监护，探讨aEEG对意识障碍患者近期预后的预测价值，同时行APACHE II、GCS评分，比较三种评估方法的优劣。对象与方法：本研究持续2+年时间（2011年12月~2014年2月），共收集91例我院神经内科重症监护病房收治的意识障碍患者。符合纳入标准78例，其中男性45例，女性33例，年龄18-83岁，平均年龄60.77±18.64。aEEG监护时间至少30min，同时在24小时内行APCHE II评分及GCS评分。应用Hosmer Lemeshow拟合优度检验评价其预测校准度，受试者工作特征曲线来评价三种评估方法的预测鉴别度。结果：实际死亡26例（33.3%），三种评估方法在全组水平的预测校准度均较佳。aEEG评分预测全组死亡16例[95％CI(9，26)]，APACHE预测死亡31例[95％CI(26，35)]，GCS判断死亡例数24例[95％CI(16，，32)]。分组校准度中aEEG及APCHE II预测校准度良好（aEEG,χ2=0，P=1,d.f.=1；APACHE, χ2=8.041，P=0.429,d.f.=8）,GCS评分预测校准度不佳（χ2=18.687，P=0.005，d.f.=6）。三种评估方法的预测鉴别度均良好，ROC曲线下面积＞0.7（aEEG0.781，APACHE II0.757，GCS0.768）。曲线下面积的差异无统计学意义。结论：aEEG对意识障碍患者近期预后有良好的预判能力。与传统APACHE II评分及GCS评分比较其预测校准度较好，鉴别能力没有差异。
[Abstract]:Objective: to evaluate the value of aEEG in predicting the short term prognosis of patients with consciousness disorder in neurology intensive care unit (NICU) by EEG monitoring, and to compare the advantages and disadvantages of the three evaluation methods. Participants and methods: the study lasted for 2 years (December 2011 to February 2014). 91 patients with consciousness disorders were admitted to intensive care unit (ICU) of neurology department in our hospital. 78 cases met the inclusion criteria, including 45 males and 33 females, aged 18-83 years, with an average age of 60.77 卤18.64.aEEG monitoring time of at least 30 minutes, and APCHE II score and GCS score within 24 hours. The predictive calibration degree was evaluated by Hosmer's Lemeshow goodness of fit test and the predictive discriminant degree of the three evaluation methods was evaluated by the operating characteristic curve of the subjects. Results: in 26 cases of actual death, the accuracy of prediction and calibration of the three evaluation methods were all better. AEEG score predicted 16 cases of death in the whole group [95CII 926] Apache predicted 31 cases of death [95CII 26 / 35] GCS estimated the number of death cases in 24 cases [95CI1632]. The predicted calibration degree of aEEG and APCHE II in grouping calibration degree was good. The calibration degree of aEEG and APCHE II was not good (蠂 ~ 2 ~ 2 ~ (18. 68) P 0.005 d.f. ~ (6), 蠂 ~ (2 +) ~ (8.041) / P ~ (0.429) d.f. ~ (8) ~ (1) ~ (1). The area under the ROC curve of the three evaluation methods was better than 0.7aEEG0.7781Ach II0.757G CS0.768. There was no significant difference in area under the curve. Conclusion: EEG has a good ability to predict the short-term prognosis of patients with disturbance of consciousness. Compared with the traditional APACHE II score and GCS score, its predictive calibration degree is better, and there is no difference in discriminant ability.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R742.1

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