入院48 h内脑电图检查在幕上大面积脑梗死患者预后及梗死后癫痫预测中的应用

发布时间：2018-06-02 10:34

本文选题：脑梗死 + 幕上大面积脑梗死　；参考：《山东医药》2017年15期

【摘要】：目的探讨入院48 h内脑电图(EEG)检查在幕上大面积脑梗死患者预后及梗死后癫痫预测中的应用价值。方法幕上大面积脑梗死患者56例,入院48 h内进行持续脑电监测,记录患者EEG变化,分别在脑电监测的起始阶段(第一次脑电评估)和终末阶段(第二次脑电评估)进行EEG分级、EEG反应性评估。发病3个月后,对患者预后及癫痫发作情况进行随访,观察两次脑电评估时患者EEG分级和EEG反应性的变化。根据格拉斯哥预后评分(GOS)评估预后。分析第二次脑电评估时患者EEG分级、EEG反应性与预后的关系。计算第二次脑电评估时EEG分级、EEG反应性预测患者预后的准确度。结果 56例中,两次脑电评估后EEG分级有变化10例、无变化46例,EEG反应性有变化5例、无变化51例。第二次脑电评估时,EEG分级好、EEG有反应者预后良好比例高于EEG分级差、EEG无反应者(P均0.05)。EEG分级、EEG反应性预测患者预后的准确度分别为89.47%、83.93%。56例中3例入院48 h内EEG可见周期性异常放电,其中1例为非惊厥性癫痫持续状态(NCSE)、2例为非惊厥性癫痫发作(NCS),3例患者均预后不良;随访过程中1例癫痫发作。结论入院48 h内EEG检查有助于预测幕上大面积脑梗死患者的预后及梗死后癫痫,EEG分级好、EEG有反应者预后相对较好,EEG可见异常放电者易发生梗死后癫痫。
[Abstract]:Objective to evaluate the value of EEGG in predicting the prognosis and post-infarction epilepsy in patients with massive supratentorial cerebral infarction (SCCI) within 48 hours after admission. Methods 56 patients with massive supratentorial cerebral infarction underwent continuous EEG monitoring within 48 hours of admission, and the changes of EEG were recorded. The EEG reactivity was evaluated at the initial stage (the first EEG evaluation) and the terminal stage (the second EEG evaluation). Three months after onset, the patients' prognosis and seizures were followed up, and the changes of EEG grade and EEG reactivity were observed during twice EEG evaluation. The prognosis was assessed according to the Glasgow prognosis score (GOS). To analyze the relationship between EEG grade and prognosis during the second EEG evaluation. To calculate the accuracy of predicting the prognosis of patients with EEG grade reactivity in the second EEG evaluation. Results among the 56 patients, 10 had changes in EEG grade after twice EEG evaluation, 5 had no change in EEG reactivity, and 51 had no change. In the second EEG evaluation, the rate of good prognosis was higher in the patients with good EEG response than that in the patients without EEG grade difference. The accuracy of predicting prognosis was 89.47% and 83.933% respectively in 3 out of 56 patients with EEG within 48 hours after admission to hospital. There were periodic abnormal discharges in EEG within 48 hours after admission. One case of NCSE was non-convulsive status epilepticus and 2 cases were non-convulsive epileptic seizure and 3 cases had poor prognosis, and 1 case had epileptic seizure during follow-up. Conclusion EEG examination within 48 hours of admission is helpful to predict the prognosis of patients with large area supratentorial cerebral infarction and the prognosis of patients with good grade of EEG after infarction.
【作者单位】：聊城市人民医院脑科医院;
【分类号】：R743.33;R742.1

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