摘要目的 探讨脑电图(EEG)反应性联合中脑形态对重型颅脑损伤昏迷患者临床预后的评估价值. 方法 选择南方医科大学附属花都医院神经外科自2011年4月至2012年10月收治的116例重型颅脑损伤昏迷患者,入院后72h内选用数字化视频EEG监测系统对患者行EEG监测,同时行头颅CT扫描并测量中脑前后径与横径的比值.统计分析患者EEG反应性、中脑前后径与横径的比值与患者预后的关系. 结果 116例患者中EEG有反应65例,无反应51例；中脑前后径与横径的比值为0.9～1.1者60例,比值＞1.1或＜0.9者56例.EEG有反应组预后良好率高于EEG无反应组,中脑前后径与横径的比值为0.9～1.1组预后良好率高于比值＞1.1或＜0.9组,差异有统计学意义(P＜ 0.05)；EEG反应性联合中脑形态评估重型颅脑损伤昏迷患者预后的敏感度、特异度均较高. 结论 EEG反应性联合中脑形态检测可有效评估重型颅脑损伤昏迷患者的预后.

abstractsObjective To investigate the relationship between electroencephalogram (EEG) reactivity combined with midbrain morphology and clinical outcomes of coma patients with severe head injury.Methods One hundred and sixteen coma patients with acute severe brain injury,admitted to our hospital from April 2011 to October 2012,were chosen in our study; EEG reactivity of the patients was monitored by digitized EEG monitoring system within 72 hours of admission,and the ratio of anteroposterior diameter and transverse diameter in the midbrain was measured under brain CT scan.The relations of EEG reactivity and ratio of anteroposterior diameter and transverse diameter with prognosis of these patients were statistically analyzed.Results Of the 116 patients,EEG reactivity examination showed response in 65 patients,including 57 patients with good prognosis; and the other 51 patients ECG reactivity showed no reaction,just 10 having good prognosis; the good prognosis rate in patients with positive EGG reactivity was significantly higher than that in patients with negative EGG reactivity (P＜0.05).According to the ratio of anteroposterior diameter and transverse diameter in the midbrain,60 patients had a ratio of 0.9 to 1.1,including 48 having good prognosis,and 56 patients had a ratio of＞1.1or＜0.9,just 19 having good prognosis; the difference was statistically significant (P＜0.05).The sensitivity and specificity in EEG reactivity combined with midbrain morphology in evaluating the prognosis of coma patients with severe traumatic brain injury were higher.Conclusion EEG reactivity combined with midbrain morphology can effectively assess the prognosis of coma patients with severe traumatic brain injury.