本文選題：重癥腦損傷 + 腦電監(jiān)測�。� 參考：《復(fù)旦大學(xué)》2012年碩士論文

【摘要】：目的對重癥腦損傷患兒VEEG腦電監(jiān)測特征和入院時GCS評分與近期預(yù)后進(jìn)行分析,探討重癥腦損傷患兒VEEG腦電活動特征與預(yù)后的相關(guān)性,及利用Young's腦電分級在重癥腦損傷患兒預(yù)后判斷中的價值。 方法選取兒童重癥監(jiān)護(hù)室(PICU)中重癥腦損傷患兒,在入住PICU時進(jìn)行GCS評分,并在入院期間患兒出現(xiàn)意識障礙發(fā)生后72h內(nèi)進(jìn)行長程視頻腦電監(jiān)測；針對刺激后腦電背景活動變化、生理睡眠結(jié)構(gòu)的存在、是否有癲癇波發(fā)放、是否存在運動性發(fā)作、是否有癲癇持續(xù)狀態(tài)發(fā)生,是否存在爆發(fā)-抑制波形、腦電活動是否表現(xiàn)為電壓低平及Young's腦電分級等腦電特征分類記錄；以患兒出院時情況為近期預(yù)后終點,運用小兒大腦與總體表現(xiàn)分類評分(PCOPCS)作為近期預(yù)后評定標(biāo)準(zhǔn)分為：預(yù)后良好組(PCOPCS:1-2分)、預(yù)后不良(PCOPCS:3-4分)、嚴(yán)重預(yù)后不良組(PCOPCS:5-6分)；并與其GCS評分和各項腦電特征進(jìn)行單因素分析(χ2檢驗)及多因素分析(logistic逐步回歸),分析影響預(yù)后的危險因素。 結(jié)果共計納入病例103例,其中男性74例,女性29例,平均年齡：3.28±3.46歲(0.12～14歲),其中預(yù)后良好組n=36,預(yù)后不良組n=30,嚴(yán)重預(yù)后不良組n=37,將近期預(yù)后分組與各項腦電特征進(jìn)行單因素分析得：入院時GCS、刺激后腦電背景活動變化、生理睡眠結(jié)構(gòu)的消失、電活動表現(xiàn)為電壓低平及Young's腦電分級在預(yù)后分組中具有統(tǒng)計學(xué)差異(P0.01)。與是否有癲癇波發(fā)放、是否存在癲癇性運動性發(fā)作、是否存在爆發(fā)-抑制波形與預(yù)后分組無明顯統(tǒng)計學(xué)差異(P0.05)。 Logistic逐步回歸分析得出：與預(yù)后相關(guān)的因素有：Young's分級(OR=1.66,95%CI1.2769-2.1623; p0.0005)與GCS評分(PR=0.809,95%CI0.7141-0.9169; p=0.001)。 結(jié)論應(yīng)用長程VEEG可作為重癥腦損傷患兒判斷預(yù)后方法,對刺激后無腦電背景活動變化(-)、生理睡眠結(jié)構(gòu)的消失、電活動表現(xiàn)為電壓低平及Young's腦電分級越高為提示預(yù)后不良的危險因素,GCS評分及Young's腦電分級在對早期預(yù)后評估具有重要價值。Young's分級標(biāo)準(zhǔn)在兒童腦損傷昏迷患兒的應(yīng)用仍有需要調(diào)整或修改之必要。
[Abstract]:Objective to investigate the correlation between VEEG EEG activity and prognosis in children with severe brain injury by analyzing the characteristics of VEEG EEG monitoring, GCS score on admission and short-term prognosis. To evaluate the prognosis of children with severe brain injury by using YoungsEEG grade. Methods Children with severe brain injury in the Children's intensive Care Unit (PICU) were selected for GCS score when they were admitted to PICU, and long-term video EEG monitoring was carried out within 72 hours after the onset of disturbance of consciousness during admission. The presence of physiological sleep structures, whether there are epileptic waves, whether there are motor seizures, whether epileptic status occurs, whether there are explosion-suppression waveforms, Whether the EEG activity is classified as low voltage level and YoungsEEG grade, and taking the discharge of the child as the short-term prognosis end point, According to PCOPCS, children were divided into good prognosis group (PCOPCS: 1-2), poor prognosis (PCOPCS: 3-4) and severe poor prognosis (PCOPCS: 5-6). Univariate analysis (蠂 2 test) and multivariate analysis (logistic stepwise regression) were performed with GCS scores and EEG features to analyze the prognostic risk factors. Results A total of 103 cases were included, including 74 males and 29 females. The average age was 3. 28 鹵3. 46 (0. 1214 years old). Among them, good prognosis group nong36, poor prognosis group nong30, severe poor prognosis group nong37. By univariate analysis of the short-term prognosis group and various EEG features, the changes of EEG background activity after GCSs stimulation were obtained. The disappearance of physiological sleep structure and electrical activity showed that there were statistical differences in the prognosis group between the low voltage level and YoungsEEG grade (P0.01). There was no significant difference between Epilepsy wave release, epileptic motor seizure, EPS and prognosis (P0.05). Logistic stepwise regression analysis showed that the prognostic factors were: 1: Youngsclassification (OR 1.2769-2.1623; p0.0005) and GCS score (PRT 0.809 ~ 95CI0.7141-0.9169; pP0.001). Conclusion Long-range VEEG can be used as a prognostic method in children with severe brain injury. The low voltage level and the higher the grade of YoungsEEG are the risk factors of poor prognosis. GCS score and YoungsEEG grade have important value in early prognostic evaluation. Youngsof grade standard should be used in children with brain injury coma. Use is still necessary to be adjusted or modified.
【學(xué)位授予單位】：復(fù)旦大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2012
【分類號】：R726.5

【參考文獻(xiàn)】

相關(guān)期刊論文 前1條

1 王曉梅,宿英英;重癥腦功能損傷的腦電圖分級標(biāo)準(zhǔn)研究[J];中華神經(jīng)科雜志;2005年02期

，

本文編號：2051972