Prognostic significance of continuous EEG monitoring in patients with poor-grade subarachnoid hemorrhage
Prognostic significance of continuous EEG monitoring in patients with poor-grade subarachnoid hemorrhage
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DOI：
10.1385/ncc:4:2:103
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发表时间：
2006-01-01
影响因子：
3.5
通讯作者：
Mayer, SA
中科院分区：
文献类型：
--
作者：
Claassen, J;Hirsch, LJ;Mayer, SA
引言：预测低分级蛛网膜下腔出血（SAH）患者的结局可能有助于指导治疗并协助家庭讨论。本研究的目的是确定连续脑电图（cEEG）监测结果是否可以预测SAH重症患者的3个月结局。方法：我们前瞻性研究了7年内756例SAH患者。3个月时采用改良兰金量表（mRS）评估功能结局。回顾性识别接受cEEG监测的患者，并收集EEG结果。结果：116例SAH患者中，cEEG监测和3个月mRS评分均为有效。在这些患者中，88%的患者入院时Hunt & Hess分级为3级或更差。在控制了年龄、Hunt & Hess分级和入院CT扫描时是否存在脑室内出血后，预后不良与睡眠结构的缺失相关（80对47%;比值比[OR] 4.3，95%置信区间[CI] 1.1-17.2）和存在周期性偏侧癫痫样放电（PLEDS）（91 vs 66% OR 1.8.8，95%-CI 1.6-214.6）。此外，所有EEG反应性缺失（n = 8）、全身周期性癫痫样放电（n = 12）或双侧独立PLEDs（n = 5）的患者结局均较差，92%的患者结局较差。（11/12）的患者为非惊厥性癫痫持续状态。即使在控制了临床和放射学检查结果后，cEEG监测也能为低级别SAH患者提供独立的预后信息。不利的发现包括周期性癫痫样放电、电图癫痫持续状态和睡眠结构的缺失。
Introduction: Predicting outcome in patients with poor-grade subarachnoid hemorrhage (SAH) may help guide therapy and assist in family discussions. The objective of this study was to determine if continuous electroencephalogram (cEEG) monitoring results are predictive of 3-month outcome in critically ill patients with SAH.Methods: We prospectively studied 756 patients with SAH over a 7-year period. Functional outcome was assessed at 3 months with the modified Rankin Scale (mRS). Patients that underwent cEEG monitoring were retrospectively identified and EEG findings were collected. Multivariate logistic regression analysis was performed to identify EEG findings associated with poor Outcome, defined as mRS 4 to 6 (dead or moderately to severely disabled).Results: In 116 patients with SAH, cEEG monitoring and 3-month mRS were available. Of these patients, 88%, had a Hunt & Hess grade of 3 or worse on admission. After controlling for age, Hunt & Hess grade, and presence of intraventricular hemorrhage on admission CT scan, poor outcome was associated with the absence of sleep architecture (80 versus 47%; odds ratio [OR] 4.3, 95%-confidence interval [CI] 1.1-17.2) and the presence of periodic lateralized epileptiform discharges (PLEDS) (91 versus 66% OR 1.8.8, 95%-CI 1.6-214.6). In addition, outcome was poor in all patients with absent EEG reactivity (n = 8), generalized periodic epileptiform discharges (n = 12), or bilateral independent PLEDs (n = 5), and in 92% (11 of 12) of patients with nonconvulsive status epilepticus.Conclusions: cEEG monitoring provides independent prognostic information in patients with poor-grade SAH, even after controlling for clinical and radiological findings. Unfavorable findings include periodic epileptiform discharges, electrographic status epilepticus, and the absence of sleep architecture.