上海交通大学学报（医学版）

上海交通大学学报（医学版）

• 论著（临床研究） • 上一篇    下一篇

N20体感诱发电位监测对颅脑创伤昏迷患者的预后判断价值

宋合保1,2，高国一1，冯军峰1，李永涛2，吕守华2，毛 青1，江基尧1   

  1. 1.上海交通大学 医学院附属仁济医院神经外科，上海市颅脑创伤研究所，上海 200127；2.滕州市中心人民医院神经外科，滕州 277500
  • 出版日期:2016-08-29 发布日期:2016-08-31
  • 通讯作者: 高国一，电子信箱：gao3@sina.com。
  • 作者简介:宋合保（1984—），男，住院医师，硕士；电子信箱：songhebao@yeah.net。
  • 基金资助:

    上海市教育委员会高峰高原学科建设计划（20152212）

Value of monitoring N20 somatosensory evoked potentials for predicting the prognosis of coma patients with traumatic brain injury

SONG He-bao1, 2, GAO Guo-yi1, FENG Jun-feng1, LI Yong-tao2, Lü Shou-hua2, MAO Qing1, JIANG Ji-yao1   

  1. 1. Department of Neurosurgery, Shanghai Institute of Head Trauma, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China; 2. Department of Neurosurgery, Tengzhou Central People’s Hospital, Tengzhou 277500, China
  • Online:2016-08-29 Published:2016-08-31
  • Supported by:

    Shanghai Municipal Education Commission—Gaofeng Clinical Medicine Grant Support, 20152212

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摘要：

目的·探讨N20体感诱发电位的连续监测结果对颅脑创伤昏迷患者的预后判断价值。方法·收集35例重型颅脑创伤格拉斯哥昏迷评分（GCS）≤8分昏迷患者的N20诱发电位数据，以N20诱发电位波幅改变、潜伏期延长作为主要观察指标，进行连续监测。除常规固定时间监测外，在急诊血肿清除术后、脑积水术前及术后、GCS评分改变后、腰椎穿刺术前后等进行监测，并结合病情进行观察分析。结果·N20诱发电位波幅是否存在、潜伏期是否延长与患者治疗过程中的病情密切相关。双侧N20均存在的患者，预后较好；仅一侧N20存在的患者，病情可在较长的时间处于相对稳定状态；双侧N20均消失的患者预后较差。结论·体感诱发电位N20的波幅、潜伏期为重型颅脑创伤昏迷患者在神经重症监护治疗阶段提供一种较为客观、简便的检查方法，可结合干预措施实施的情况为患者提供预后分析。

关键词: 体感诱发电位, N20, 颅脑创伤, 昏迷, 预后

Abstract:

Objective · To explore the value of continuous monitoring of N20 somatosensory evoked potentials for predicting the prognosis of coma patients with traumatic brain injury. Methods · N20 evoked potential data from 35 patients with severe traumatic brain injury whose Glasgow Coma Scale (GCS) scores were ≤8 points were collected. Continuous monitoring was performed with changes in amplitude and prolonged latency of N20 evoked potential as major monitoring indexes. Apart from routine regular monitoring, monitoring was also performed after emergency hematoma removal, before changes in GCS scores, and before and after hydrocephalus shunt surgery and lumbar puncture procedure. Observation and analysis were conducted in conjunction with patient's conditions. Results · The presence of the amplitude of N20 evoked potential and prolonged latency were closely related to patient's conditions. The prognosis of patients with presence of bilateral N20 was favorable. Conditions of patients with presence of unilateral N20 were relatively stable for a long period of time. The prognosis of patients with absence of bilateral N20 was poor. Conclusion · The amplitude and latency of somatosensory evoked potential N20 provide an objective and simple monitoring method for coma patients with traumatic brain injury during neurological intensive care, as well as prognosis analysis in conjunction with intervention measures.

Key words: somatosensory evoked potential, N20, traumatic brain injury, coma, prognosis