Continuous electroencephalography in a surgical intensive care unit
Continuous electroencephalography in a surgical intensive care unit
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DOI：
10.1007/s00134-013-3149-8
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发表时间：
2014-02-01
影响因子：
38.9
通讯作者：
Claassen, Jan
中科院分区：
文献类型：
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作者：
Kurtz, Pedro;Gaspard, Nicolas;Claassen, Jan
目的：我们的目的是研究连续脑电图（cEEG）监测的外科重症监护室（SICU）患者中非惊厥性癫痫发作（NCSz）、非惊厥性癫痫持续状态（NCSE）和周期性癫痫样放电（PED）的患病率、风险因素及其对结局的影响。方法：这是一项回顾性研究的SICU患者谁接受了cEEG监测改变精神状态超过6年的时间。我们报告了cEEG上NCSZ（包括NCSE）和PED的频率。主要结局为出院时死亡或严重残疾。多变量逻辑回归用于确定NCSz（包括NCSE）和PED是否与不良结局（死亡、植物人状态或重度残疾）独立相关。结果：154例患者中，平均年龄为64 ± 14岁，40%为女性。大多数患者在腹部手术（36%）和肝移植（24%）后入院。100例（65%）患者发生脓毒症。16%（n = 24）患有NCSz [包括5%（N = 8）患有NCSE]，29%（N = 45）患有PED。所有8例NCSE患者均为脓毒症。与未发生NCSz或NCSE的患者相比，发生NCSz或NCSE的患者在cEEG和昏迷之前的临床癫痫发作更常见（分别为70 vs. 27%; p < 0.01; 75 vs. 52%; p = 0.046和63 vs. 34%; p = 0.09）。NCSZ（包括NCSE）与不良结局独立相关（20 vs. 3%，OR 10.4，95%CI 1.0-53.7; p = 0.039）。结论：在这项回顾性研究中，SICU患者通过cEEG监测精神状态改变，NCSz和周期性放电频繁，NCSz与不良结局独立相关。临床癫痫发作发生在cEEG之前时，NCSz更常见。
Purpose: Our aim was to investigate the prevalence, risk factors, and impact on outcome of nonconvulsive seizures (NCSz), nonconvulsive status epilepticus (NCSE), and periodic epileptiform discharges (PEDs) in surgical intensive care unit (SICU) patients with continuous electroencephalography (cEEG) monitoring. Methods: This was a retrospective study of SICU patients who underwent cEEG monitoring for altered mental status over a 6-year period. We report the frequency of NCSz (including NCSE) and PEDs on cEEG. The primary outcome was death or severe disability at hospital discharge. Multivariable logistic regression was used to identify whether NCSz (including NCSE) and PEDs were independently associated with poor outcome (death, vegetative state or severe disability). Results: Of 154 patients, the mean age was 64 +/- 14 years old, and 40 % were women. The majority of patients were admitted following abdominal surgery (36 %) and liver transplantation (24 %). Sepsis developed in 100 (65 %) patients. Sixteen percent (n = 24) had NCSz [including 5 % (N = 8) with NCSE], and 29 % (N = 45) had PEDs. All eight patients with NCSE were septic. Clinical seizures prior to cEEG and coma were more common among patients who developed NCSz or NCSE compared to patients without NCSz or NCSE (70 vs. 27 %; p < 0.01; 75 vs. 52 %; p = 0.046 and 63 vs. 34 %; p = 0.09, respectively). NCSzs (including NCSE) were independently associated with poor outcome (20 vs. 3 %, OR 10.4, 95 % CI 1.0-53.7; p = 0.039). Conclusion: In this retrospective study of SICU patients with cEEG monitoring for altered mental status, NCSz and periodic discharges were frequent and NCSz were independently associated with poor outcome. NCSz were more common when clinical seizures occurred before cEEG.