摘要
目的:探讨体感诱发电位参数N20评价意识障碍患者预后的价值。方法:回顾性分析110例因各种因素(外伤、心肺复苏术后、缺血缺氧、脑血管病等)导致意识障碍患者的病史、病程和体感诱发电位N20的数据;并进行1年的随访,观察患者预后转归。采用描述性分析,独立样本t检验、ROC曲线及Kaplan-Meier分析等方法进行统计学分析。结果:110例意识障碍患者随访中死亡2例予以剔除,共纳入分析病例108例。根据意识恢复情况分为:意识恢复组(52例);意识未恢复组(56例)。N20潜伏期判断患者预后有着较好的评判价值(ROC曲线下面积分别为C3-’N20:77.6%,C4-’N20:79.3%),意识恢复组双侧N20潜伏期均较意识未恢复组短,但两组患者的波幅差异均无统计学意义。C4-’N20潜伏期界定为20.05 ms时及C3-’N20潜伏期界定为19.95 ms时有着较好的敏感度和特异度(C4-’N20:70.8%,75.0%,C3-’N20:75.0%,72.0%);Kaplan-Meier分析结果显示C3-’N20潜伏期<19.95 ms及C4-’N20潜伏期<20.05 ms的患者1年内能够恢复的概率最大,恢复时间最短。结论:体感诱发电位N20潜伏期能够较好评价意识障碍患者预后,其中以C4-’N20潜伏期20.05 ms及C3-’N20潜伏期19.95 ms为较好的界定值。
Aim：To evaluate the quantitative information of N20,a main component of SEP,in the prognosis of patients with conscious disturbance after a year.Methods：N20 data and clinic cases histories of the patients with conscious disturbance caused by different factors form July 2005 to July 2009 were retrospectively reviewed.Different statistical methods such as t test,Mann-Whitney U test,c2 test,ROC curves,Kaplan-Meier analysis were used to compare the parameters of bilateral N20 between the awakened group and the unawakened group and to estimate the patients＇ prognosis.Results：Bilateral N20 could be used to predict the prognosis of patients with conscious disturbance（the area under ROC curve of C3＇-N20 latency occupied 77.6% and the area under ROC curve of C4＇-N20 latency occupied 79.3%）.The bilateral average N20 latencies of the patients still in conscious disturbance were statistically longer than the ones of the patients could have been awaken,however there was no statistical difference in bilateral N20 amplitudes between the two groups.The sensitivity and specificity were 70.8% and 75.0% separately at the point of C4＇-N20 latency being 20.05 ms which was the best estimated and 75.0% and 72% separately at the point of C4＇-N20 latency being 19.95 ms.The prognosis of the patients in conscious disturbance with C3＇-N20 latency19.95 ms and C4＇-N20 latency20.05 ms after one year were the best,with the smallest percentage of the patients still in conscious disturbance 1 year later and the shortest average time which they took to recover from conscious disturbance.Conclusion：The bilateral N20 latencies are considered as an accurate index to predict the prognoses of patients with conscious disturbance,when the patients with bilaterally N20 existent had the best outcomes.The point of C3＇-N20 latency being 19.95 ms and the point of C4＇-N20 latency being 20.05 ms were considered as the best boundaries that could separate the patients whether they had good outcomes or not,with the best sensitivity and specificity.
出处
《中国临床神经科学》
2011年第4期377-381,共5页
Chinese Journal of Clinical Neurosciences
关键词
体感诱发电位
N20波
意识障碍
预后
somatosensory evoked potential
N20 wave
conscious disturbance
prognoses
