無創(chuàng)腦電阻抗檢測在神經(jīng)科的應(yīng)用研究
發(fā)布時間：2018-09-11 21:12
【摘要】：研究背景與目的：顱內(nèi)壓增高和腦水腫是神經(jīng)科疾病及其它全身疾病常見的一種并發(fā)癥，會影響腦血流灌注、缺血、繼發(fā)性腦損傷。目前，對于高顱壓或腦水腫的診斷主要依據(jù)臨床表現(xiàn)、眼底檢查、頭顱CT和MRI影像學(xué)檢查、腰椎穿刺以及顱內(nèi)壓監(jiān)測等幾個方面。無創(chuàng)腦電阻抗技術(shù)是應(yīng)用于人體腦組織的一項新技術(shù)，操作方法簡單、無創(chuàng)傷，能對顱內(nèi)壓進行連續(xù)動態(tài)監(jiān)測，可直接得出反應(yīng)腦水腫狀況的電阻抗擾動系數(shù)值。本實驗采用重慶BORN-BE公司生產(chǎn)的無創(chuàng)腦水腫動態(tài)監(jiān)護儀對可能伴有腦水腫或顱內(nèi)壓增高的患者（包括腦梗死、腦出血、腦積水、腦炎和各類腦病以及頭痛等）進行腦電阻抗測定，探討腦電阻抗擾動系數(shù)與各種神經(jīng)疾病和各種病理生理情況的關(guān)系，包括發(fā)病時間和病程、病變部位和體積、腰穿腦脊液壓力等的關(guān)系，評價無創(chuàng)腦水腫監(jiān)護儀在神經(jīng)重癥監(jiān)護的實用性和有效性。 對象和方法：2010年7月至2012年2月沈陽軍區(qū)總醫(yī)院神經(jīng)內(nèi)科住院和門診患者共132例。腦梗死85例：男48例，女37例，年齡40～78歲，平均年齡59±9.3歲，符合1995年中華醫(yī)學(xué)會第四次全國腦血管病學(xué)術(shù)會議修訂標(biāo)準(zhǔn)，所有病例均不包括腔隙性梗死；腦出血8例：男6例，女2例，平均年齡55±14.5歲，符合1995年中華醫(yī)學(xué)會第四次全國腦血管病學(xué)術(shù)會議修訂標(biāo)準(zhǔn),GCS評分在8分以上，采取內(nèi)科保守治療�；坠�(jié)區(qū)出血2例，丘腦出血破入腦室的患者2例，基底節(jié)區(qū)出血破入腦室3例，小腦出血1例。入院時血腫體積（出血量）為6～62ml，平均39.14±8.71ml。病毒性腦炎11例，男6例，女5例，平均年齡38±8.3歲。腦病10例：腦白質(zhì)病變5例，代謝性腦病5例，男6例，女4例，平均年齡42±8.7歲。頭痛患者10例，男5例，女5例，平均年齡32±9.4歲。腦積水患者8例，男3例，女5例，平均年齡35±3.5歲。根據(jù)頭顱CT或MRI檢查計算腦梗死和腦出血患者病灶體積及病灶最大徑，與所測電阻抗（CEI）值進行相關(guān)性分析。行腰穿檢查的患者，測定腦脊液（CSF）壓力值的同時行無創(chuàng)腦水腫監(jiān)測，將所測定的CSF壓力值與CEI值進行相關(guān)性分析。 結(jié)果： 1.132例不同神經(jīng)疾病患者的測定結(jié)果，CEI升高的異常率有所不同。腦梗死66.0%，腦出血50%，病毒性腦炎63.6%，腦病70%，頭痛70%，腦積水37.5%。 2.37例次腰穿壓力與CEI值作直線相關(guān)分析。直線方程為y=6.48x+78.28(y代表腰穿壓力，x為對應(yīng)CEI值)，腰穿壓力與CEI值兩者呈正相關(guān)（r=0.654，p＜0.05，n=37）。同一患者行多次腰穿，CEI值與腦脊液壓力值呈正相關(guān)（r=0.855，p＜0.05），直線方程為y=8.78x+66.98(y代表腰穿壓力，x為對應(yīng)CEI值)。 3.腦梗死：CEI值在腦梗死患者發(fā)病后逐漸升高，發(fā)病后4～7天達(dá)到高峰，隨后逐漸回落。4～7天時梗死側(cè)與梗死對側(cè)大腦半球CEI值出現(xiàn)分離，即梗死側(cè)CEI值高于梗死對側(cè)。腦梗死發(fā)病后4～7天時，，梗死側(cè)大腦半球CEI值為13.59±3.10，明顯高于發(fā)病后1～3天時的CEI值（10.86±2.14）和發(fā)病7天后的CEI值（11.18±2.38），p＜0.05，也高于同時期梗死對側(cè)大腦半球CEI值（11.53±3.44），p＜0.05。腦梗死部位不同，CEI異常率不同。大腦皮質(zhì)梗死和基底節(jié)區(qū)梗死異常率分別為85.6%和74.5%，而腦干和小腦梗死的異常率僅18.8%。結(jié)果提示，梗死灶越靠近皮質(zhì)，CEI異常率越高。腦梗死患者梗死側(cè)CEI值與梗死體積呈正相關(guān)，直線方程為：y=10.9x-24.653（n=65，r=0.552，P＜0.01）。 4.腦出血：腦出血后1～3天、4～7天以及＞7天所測得的血腫側(cè)大腦半球CEI值分別為11.56±2.34、12.98±2.60和9.54±1.98，血腫對側(cè)大腦半球CEI值分別為9.45±2.23、10.01±2.54和8.04±1.78。腦出血后1～3天和4～7天，血腫側(cè)與血腫對側(cè)大腦半球阻抗值比較有顯著差異（p＜0.01）。無創(chuàng)腦水腫監(jiān)護儀監(jiān)測20例次，所得的CEI值與血腫體積做相關(guān)分析,P＞0.05。按出血有無破入腦室分為：伴腦室積血40%，無腦室積血66.7%。 5.11例病毒性腦炎，無創(chuàng)腦水腫監(jiān)測15例次，腰穿腦脊液壓力與所測電阻抗值呈線性關(guān)系，直線方程為Y=8.78x+56.9(Y：腰穿壓力，x：對應(yīng)的CEI值)，p＜0.01,r=0.634。 6.各種腦病的CEI值均高于正常，而雙側(cè)CEI值分別為14.18±2.79和14.17±2.98，P＞0.05,差異無統(tǒng)計學(xué)意義。 7.10例頭痛患者，CEI值高于正常。其中2例行腰穿檢查，腰穿CSF壓力在正常范圍。 8.不同年齡、性別監(jiān)測的CEI值的差異無統(tǒng)計學(xué)意義（P0.05）。 結(jié)論： 1.無創(chuàng)腦水腫測定可較敏感地反應(yīng)顱內(nèi)壓力；CEI與腰穿壓力值呈正相關(guān)，CEI越高，提示腰穿壓力越高。 2.無創(chuàng)腦水腫測定可較敏感地反應(yīng)腦梗死和腦出血后腦水腫的變化，CEI值越高，提示水腫更嚴(yán)重，梗死或出血的病灶體積更大。無創(chuàng)腦水腫監(jiān)測對大腦半球腦梗死更敏感。 3.無創(chuàng)腦水腫測定是一種簡便、無創(chuàng)的檢查方法，能對各種腦部疾病（缺血、出血、損傷、中毒、炎癥等）產(chǎn)生的顱內(nèi)壓增高和腦水腫的程度做出初步判斷，對神經(jīng)科臨床工作有指導(dǎo)作有用。
[Abstract]:BACKGROUND AND OBJECTIVE: Increased intracranial pressure and brain edema are common complications of neurological diseases and other systemic diseases, which may affect cerebral blood flow perfusion, ischemia, and secondary brain injury. Non-invasive brain electrical impedance technique is a new technique applied to human brain tissue. It is simple and non-invasive. It can monitor the intracranial pressure continuously and dynamically. The value of electrical impedance perturbation coefficient can be obtained directly, which can reflect the condition of brain edema. Brain electrical impedance measurements were performed in patients with possible cerebral edema or elevated intracranial pressure (including cerebral infarction, cerebral hemorrhage, hydrocephalus, encephalitis, various encephalopathy and headache, etc.) to investigate the relationship between the disturbance coefficient of brain electrical impedance and various neurological diseases and various pathophysiological conditions, including the time and course of the disease, the location and volume of the lesion, and the waist. To evaluate the practicability and effectiveness of noninvasive brain edema monitor in neurological intensive care.
PARTICIPANTS AND METHODS: From July 2010 to February 2012, 132 inpatients and outpatients in the Department of Neurology, General Hospital of Shenyang Military Region were enrolled. 85 patients with cerebral infarction, 48 males and 37 females, aged 40-78 years, with an average age of 59 (+ 9.3), met the revised criteria of the Fourth National Conference on Cerebrovascular Diseases of the Chinese Medical Association in 1995. Eight patients died of cerebral hemorrhage: 6 males and 2 females, with an average age of 55 65507 11 cases of viral encephalitis, 6 males and 5 females, with an average age of 38.3 years. 10 cases of encephalopathy: 5 cases of leukoencephalopathy, 5 cases of metabolic encephalopathy, 6 males and 4 females, with an average age of 42.7 years. 10 cases of headache, 5 males and 5 females, with an average age of 32.9.4 years. There were 3 males and 5 females with an average age of 35 (+ 3.5 years). The lesion volume and the maximum diameter of lesions were calculated by CT or MRI, and the correlation between the lesion volume and CEI was analyzed. Correlation analysis was performed.
Result:
The abnormal rate of CEI elevation was different in 132 patients with different neurological diseases, including cerebral infarction 66.0%, cerebral hemorrhage 50%, viral encephalitis 63.6%, encephalopathy 70%, headache 70%, hydrocephalus 37.5%.
The linear equation was y = 6.48x + 78.28 (y represents lumbar puncture pressure, x corresponds to CEI value). The lumbar puncture pressure was positively correlated with CEI value (r = 0.654, P < 0.05, n = 37). Multiple lumbar punctures were performed in the same patient. The CEI value was positively correlated with CSF pressure (r = 0.855, P < 0.05), and the linear equation was y = 8.78x + 66.98 (y = 8.78x + 66.98). It represents waist pressure and X corresponds to CEI.
3. Cerebral infarction: CEI value gradually increased in patients with cerebral infarction, reached a peak 4-7 days after the onset, and then gradually decreased. 4-7 days after the onset of cerebral infarction and infarction on the opposite side of the cerebral hemisphere CEI value separated, that is, the infarct side of the CEI value was higher than the opposite side of the infarction. The CEI values at 1-3 days after onset (10.86+2.14) and 7 days after onset (11.18+2.38), P < 0.05, were also higher than those in the contralateral cerebral hemisphere (11.53+3.44), P < 0.05. The abnormal rates of CEI were different in different infarct sites, 85.6% in cerebral cortex infarction and 74.5% in basal ganglia infarction, and 85.6% in brainstem and 74.5% in cerebellar infarction. The abnormal rate of CEI was only 18.8%. The results showed that the closer the infarct was to the cortex, the higher the abnormal rate of CEI was.
4. Intracerebral hemorrhage: The CEI values of hematoma hemisphere were 11.56 (+ 2.34), 12.98 (+ 2.60) and 9.54 (+ 1.98) on the 1-3 days, 4-7 days and > 7 days after intracerebral hemorrhage, respectively. The CEI values of hematoma hemisphere on the opposite side were 9.45 (+ 2.23), 10.01 (+ 2.54) and 8.04 (+ 1.78), respectively. There was significant difference (p < 0.01). 20 cases were monitored by non-invasive brain edema monitor. The CEI value was correlated with the volume of hematoma (P > 0.05). According to whether the hemorrhage broke into the ventricle, it was divided into 40% with ventricular hemorrhage and 66.7% without ventricular hemorrhage.
In 5.11 cases of viral encephalitis, 15 cases of non-invasive brain edema were monitored. The linear equation was Y = 8.78x + 56.9 (Y: lumbar puncture pressure, x: corresponding CEI value), P < 0.01, r = 0.634.
6. The CEI values of all kinds of encephalopathy were higher than normal, while the bilateral CEI values were 14.18 (+ 2.79) and 14.17 (+ 2.98) respectively, P > 0.05, with no significant difference.
In 7.10 patients with headache, the CEI value was higher than normal, 2 of them underwent lumbar puncture, and the pressure of lumbar puncture CSF was within normal range.
8. there was no significant difference in CEI between different age and sex monitoring (P0.05).
Conclusion:
1. Non-invasive brain edema measurement can more sensitive response to intracranial pressure; CEI and lumbar puncture pressure was positively correlated, the higher the CEI, suggesting the higher the lumbar puncture pressure.
2. Non-invasive brain edema measurement can more sensitively reflect the changes of cerebral edema after cerebral infarction and cerebral hemorrhage. The higher the CEI value, the more serious the edema, the larger the size of the infarction or hemorrhage. Non-invasive brain edema monitoring is more sensitive to cerebral infarction.
3. Non-invasive brain edema measurement is a simple and non-invasive method, which can make a preliminary judgment on the increase of intracranial pressure and the degree of brain edema caused by various brain diseases (ischemia, hemorrhage, injury, poisoning, inflammation, etc.). It is useful to guide the clinical work of neurology.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2012
【分類號】：R741.044
本文編號：2237850
[Abstract]:BACKGROUND AND OBJECTIVE: Increased intracranial pressure and brain edema are common complications of neurological diseases and other systemic diseases, which may affect cerebral blood flow perfusion, ischemia, and secondary brain injury. Non-invasive brain electrical impedance technique is a new technique applied to human brain tissue. It is simple and non-invasive. It can monitor the intracranial pressure continuously and dynamically. The value of electrical impedance perturbation coefficient can be obtained directly, which can reflect the condition of brain edema. Brain electrical impedance measurements were performed in patients with possible cerebral edema or elevated intracranial pressure (including cerebral infarction, cerebral hemorrhage, hydrocephalus, encephalitis, various encephalopathy and headache, etc.) to investigate the relationship between the disturbance coefficient of brain electrical impedance and various neurological diseases and various pathophysiological conditions, including the time and course of the disease, the location and volume of the lesion, and the waist. To evaluate the practicability and effectiveness of noninvasive brain edema monitor in neurological intensive care.
PARTICIPANTS AND METHODS: From July 2010 to February 2012, 132 inpatients and outpatients in the Department of Neurology, General Hospital of Shenyang Military Region were enrolled. 85 patients with cerebral infarction, 48 males and 37 females, aged 40-78 years, with an average age of 59 (+ 9.3), met the revised criteria of the Fourth National Conference on Cerebrovascular Diseases of the Chinese Medical Association in 1995. Eight patients died of cerebral hemorrhage: 6 males and 2 females, with an average age of 55 65507 11 cases of viral encephalitis, 6 males and 5 females, with an average age of 38.3 years. 10 cases of encephalopathy: 5 cases of leukoencephalopathy, 5 cases of metabolic encephalopathy, 6 males and 4 females, with an average age of 42.7 years. 10 cases of headache, 5 males and 5 females, with an average age of 32.9.4 years. There were 3 males and 5 females with an average age of 35 (+ 3.5 years). The lesion volume and the maximum diameter of lesions were calculated by CT or MRI, and the correlation between the lesion volume and CEI was analyzed. Correlation analysis was performed.
Result:
The abnormal rate of CEI elevation was different in 132 patients with different neurological diseases, including cerebral infarction 66.0%, cerebral hemorrhage 50%, viral encephalitis 63.6%, encephalopathy 70%, headache 70%, hydrocephalus 37.5%.
The linear equation was y = 6.48x + 78.28 (y represents lumbar puncture pressure, x corresponds to CEI value). The lumbar puncture pressure was positively correlated with CEI value (r = 0.654, P < 0.05, n = 37). Multiple lumbar punctures were performed in the same patient. The CEI value was positively correlated with CSF pressure (r = 0.855, P < 0.05), and the linear equation was y = 8.78x + 66.98 (y = 8.78x + 66.98). It represents waist pressure and X corresponds to CEI.
3. Cerebral infarction: CEI value gradually increased in patients with cerebral infarction, reached a peak 4-7 days after the onset, and then gradually decreased. 4-7 days after the onset of cerebral infarction and infarction on the opposite side of the cerebral hemisphere CEI value separated, that is, the infarct side of the CEI value was higher than the opposite side of the infarction. The CEI values at 1-3 days after onset (10.86+2.14) and 7 days after onset (11.18+2.38), P < 0.05, were also higher than those in the contralateral cerebral hemisphere (11.53+3.44), P < 0.05. The abnormal rates of CEI were different in different infarct sites, 85.6% in cerebral cortex infarction and 74.5% in basal ganglia infarction, and 85.6% in brainstem and 74.5% in cerebellar infarction. The abnormal rate of CEI was only 18.8%. The results showed that the closer the infarct was to the cortex, the higher the abnormal rate of CEI was.
4. Intracerebral hemorrhage: The CEI values of hematoma hemisphere were 11.56 (+ 2.34), 12.98 (+ 2.60) and 9.54 (+ 1.98) on the 1-3 days, 4-7 days and > 7 days after intracerebral hemorrhage, respectively. The CEI values of hematoma hemisphere on the opposite side were 9.45 (+ 2.23), 10.01 (+ 2.54) and 8.04 (+ 1.78), respectively. There was significant difference (p < 0.01). 20 cases were monitored by non-invasive brain edema monitor. The CEI value was correlated with the volume of hematoma (P > 0.05). According to whether the hemorrhage broke into the ventricle, it was divided into 40% with ventricular hemorrhage and 66.7% without ventricular hemorrhage.
In 5.11 cases of viral encephalitis, 15 cases of non-invasive brain edema were monitored. The linear equation was Y = 8.78x + 56.9 (Y: lumbar puncture pressure, x: corresponding CEI value), P < 0.01, r = 0.634.
6. The CEI values of all kinds of encephalopathy were higher than normal, while the bilateral CEI values were 14.18 (+ 2.79) and 14.17 (+ 2.98) respectively, P > 0.05, with no significant difference.
In 7.10 patients with headache, the CEI value was higher than normal, 2 of them underwent lumbar puncture, and the pressure of lumbar puncture CSF was within normal range.
8. there was no significant difference in CEI between different age and sex monitoring (P0.05).
Conclusion:
1. Non-invasive brain edema measurement can more sensitive response to intracranial pressure; CEI and lumbar puncture pressure was positively correlated, the higher the CEI, suggesting the higher the lumbar puncture pressure.
2. Non-invasive brain edema measurement can more sensitively reflect the changes of cerebral edema after cerebral infarction and cerebral hemorrhage. The higher the CEI value, the more serious the edema, the larger the size of the infarction or hemorrhage. Non-invasive brain edema monitoring is more sensitive to cerebral infarction.
3. Non-invasive brain edema measurement is a simple and non-invasive method, which can make a preliminary judgment on the increase of intracranial pressure and the degree of brain edema caused by various brain diseases (ischemia, hemorrhage, injury, poisoning, inflammation, etc.). It is useful to guide the clinical work of neurology.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2012
【分類號】：R741.044
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