Bedside quantitative electroencephalography improves assessment of consciousness in comatose subarachnoid hemorrhage patients.
Bedside quantitative electroencephalography improves assessment of consciousness in comatose subarachnoid hemorrhage patients.
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DOI：
10.1002/ana.24752
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发表时间：
2016-10
影响因子：
11.2
通讯作者：
Frey, Hans-Peter
中科院分区：
文献类型：
--
作者：
Claassen, Jan;Velazquez, Angela;Meyers, Emma;Witsch, Jens;Falo, M. Cristina;Park, Soojin;Agarwal, Sachin;Schmidt, J. Michael;Schiff, Nicholas D.;Sitt, Jacobo D.;Naccache, Lionel;Connolly, E. Sander;Frey, Hans-Peter
准确的意识行为评估在指导治疗方面具有重要意义，但在急性脑损伤患者中极具挑战性。我们评估了脑电图和多模态监测参数是否有助于评估蛛网膜下腔出血患者的意识。对83例连续治疗的成人蛛网膜下腔出血患者进行了回顾性分析。所有患者最初都处于昏迷状态，并进行了侵入性脑监测。在每日镇静中断期间进行行为评估，并根据其最佳检查分为三组：（1）昏迷，（2）唤醒（睁眼或注意刺激）和（3）意识（遵循命令）。EEG特征包括频谱功率和复杂性测量。使用自举法和偏最小二乘回归进行比较。我们在行为评估后确定了389个无伪影EEG片段。增加中央伽玛，后α，和弥漫性θ-δ振荡区分患者唤醒昏迷。命令跟随的特征是中央伽马和后α的进一步增加，以及α排列熵的增加。这些EEG特征连同基本神经学检查（例如，瞳孔光反射）对预测行为状态的线性模型贡献很大，而脑生理学测量（例如，脑氧合）、结构损伤和临床病程增加较少。行为状态的EEG测量提供了独特的特征，补充了损伤后不久蛛网膜下腔出血患者的行为评估。我们的数据支持这一假设，受损的连接皮层与中央丘脑和基底前脑的意识水平下降的基础。
Accurate behavioral assessments of consciousness carry tremendous significance in guiding management, but are extremely challenging in acutely brain-injured patients. We evaluated whether EEG and multimodality monitoring parameters may facilitate assessment of consciousness in patients with subarachnoid hemorrhage. A retrospective analysis was performed of 83 consecutively treated adults with subarachnoid hemorrhage. All patients were initially comatose and had invasive brain monitoring placed. Behavioral assessments were performed during daily interruption of sedation and categorized into three groups based on their best examination as (1) comatose, (2) arousable (eye opening or attending towards a stimulus), and (3) aware (command following). EEG features included spectral power and complexity measures. Comparisons were made using bootstrapping methods and partial least squares regression. We identified 389 artifact-free EEG clips following behavioral assessments. Increasing central gamma, posterior alpha, and diffuse theta-delta oscillations differentiated patients that were arousable from those in coma. Command following was characterized by a further increase in central gamma and posterior alpha, as well as an increase in alpha permutation entropy. These EEG features together with basic neurological examinations (e.g., pupillary light reflex) contributed heavily to a linear model predicting behavioral state while brain physiology measures (e.g., brain oxygenation), structural injury, and clinical course added less. EEG measures of behavioral states provide distinctive signatures that complement behavioral assessments of patients with subarachnoid hemorrhage shortly after the injury. Our data support the hypothesis that impaired connectivity of cortex with both central thalamus and basal forebrain underlies decreasing levels of consciousness.
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DOI：
10.1073/pnas.1011949107
发表时间：
2010-12-07
影响因子：
11.1
作者：
Breshears, Jonathan D.;Roland, Jarod L.;Leuthardt, Eric C.
通讯作者：
Leuthardt, Eric C.
影响因子：
--
作者：
Bardin, Jonathan C.;Schiff, Nicholas D.;Voss, Henning U.
通讯作者：
Voss, Henning U.
影响因子：
9.9
作者：
Becker, KJ;Baxter, AB;Longstreth, WT
通讯作者：
Longstreth, WT
影响因子：
4.7
作者：
Hall, Stephen D.;Yamawaki, Naoki;Stanford, Ian M.
通讯作者：
Stanford, Ian M.
影响因子：
11.2
作者：
Claassen, Jan;Albers, David;Badjatia, Neeraj
通讯作者：
Badjatia, Neeraj