Quantitative continuous EEG for detecting delayed cerebral ischemia in patients with poor-grade subarachnoid hemorrhage
Quantitative continuous EEG for detecting delayed cerebral ischemia in patients with poor-grade subarachnoid hemorrhage
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DOI：
10.1016/j.clinph.2004.06.017
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发表时间：
2004-12-01
影响因子：
4.7
通讯作者：
Mayer, SA
中科院分区：
文献类型：
--
作者：
Claassen, J;Hirsch, LJ;Mayer, SA
目的：重度蛛网膜下腔出血（SAH）患者因血管痉挛引起的迟发性脑缺血（DCI）在临床检查中往往未被发现。本研究的目的是确定定量脑电图（qEEG）参数，以最敏感和特异性地检测昏迷或昏迷SAH患者的DCI。方法：在神经icu连续住院的78例Hunt-Hess 4级或5级SAH患者中，48例符合参与条件，34例入组。术后第2天至sah后第14天进行连续脑电图监测。在每个患者中，分析20个无伪影的，在警报刺激后1分钟的脑电图片段：10个片段在监测第1天（基线）获得，10个片段在监测第4-6天（随访）获得。在DCI患者中，随访片段在病情恶化开始后和梗塞发生前获得。采用快速傅里叶变换计算了12个qEEG参数；采用广义估计方程比较有DCI和无DCI患者qEEG参数的变化率。结果：34例患者中有9例（26%）发生DCI。alpha/delta比值（alpha power/delta power； ADR）与DCI的相关性最强。有DCI患者的ADR中位数下降24%，而无DCI患者的ADR中位数下降3% (Z=4.0， ADR较基线下降10%（敏感性100%，特异性76%），任何单一测量均下降50%（敏感性89%，特异性84%）。结论：降低不良反应可能是检测DCI的一种敏感方法，具有合理的特异性。这种刺激后的qEEG参数可以补充不良SAH患者的临床检查，并可能被证明对DCI的检测有用。意义：跟踪不良反应可能允许早期发现DCI并在可逆阶段开始干预，从而预防梗死和神经系统疾病。(C) 2004年国际临床神经生理学联合会。爱思唯尔爱尔兰有限公司出版。版权所有。
Objective: Delayed cerebral ischemia (DCI) due to vasospasm is often undetected by clinical exam in patients with poor-grade subarachnoid hemorrhage (SAH). The purpose of this study was to identify quantitative EEG (qEEG) parameters that are most sensitive and specific for the detection of DCI in stuporous or comatose SAH patients.Methods: Of 78 consecutive Hunt-Hess grade 4 or 5 SAH patients admitted to our Neuro-ICU over a 2-year period, 48 were eligible for participation and 34 were enrolled. Continuous EEG monitoring was performed from post-operative day 2 to post-SAH day 14. In each patient, 20 artifact-free, 1 min EEG-clips following an alerting stimulus were analyzed: 10 clips were obtained on monitoring day I (baseline), and 10 on days 4-6 (follow-up). In DCI patients, follow-up clips were obtained after the onset of deterioration and before infarction had occurred. Twelve qEEG parameters were calculated using fast Fourier transformation; generalized estimating equations were used to compare ratios of change in qEEG parameters in patients with and without DCI.Results: Nine of 34 patients (26%) developed DCI. The alpha/delta ratio (alpha power/delta power; ADR) demonstrated the strongest association with DCI. The median decrease of ADR for patients with DCI was 24%, compared to an increase of 3% for patients without DCI (Z=4.0, P10% decrease in ADR from baseline (sensitivity 100%, specificity 76%) and any single measurement with a >50% decrease (sensitivity 89%, specificity 84%).Conclusions: A decrease in the ADR may be a sensitive method of detecting DCI, with reasonable specificity. This post-stimulation qEEG parameter may supplement the clinical exam in poor-grade SAH patients and may prove useful for the detection of DCI.Significance: Following ADRs may allow earlier detection of DCI and initiation of interventions at a reversible stage, thus preventing infarction and neurological morbidity. (C) 2004 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.