摘要
目的探讨术后早期脑电双频指数(BIS)对高分级(Hunt-Hess分级Ⅵ~Ⅴ级)动脉瘤性蛛网膜下腔出血(a SAH)病人术后意识恢复的预测价值。方法选择2015年1月至2021年12月手术治疗的156例高分级a SAH,术后3 d记录BIS值,并计算BIS低值、高值、均值;术后随访6个月,根据GCS评分评估意识恢复情况,GCS评分≥13分判定为意识恢复。结果156例中,术后6个月意识恢复76例;意识未恢复80例,其中昏迷45例,死亡35例。意识恢复组BIS低值、高值、均值较意识未恢复组均显著增高(P<0.01)。ROC曲线分析显示,BIS低值、高值、均值预测意识恢复的曲线下面积分别为0.758(95%CI 0.682~0.834)、0.866(95%CI 0.808~0.924)、0.830(95%CI 0.765~0.895)。BIS低值≥41预测意识恢复的敏感度为73.7%、特异度为67.5%,阳性预测值为68.3%,阴性预测值为73.0%;BIS高值≥55预测意识恢复的敏感度为92.1%、特异度为75.0%,阳性预测值为77.8%,阴性预测值为90.9%;BIS均值≥47预测意识恢复的敏感度为86.8%,特异度为73.8%,阳性预测值为75.9%,阴性预测值为85.5%。结论BIS能客观地反映脑电活动,可以预测高分级aSAH术后意识恢复情况,其中BIS高值预测准确性最高。
Objective To investigate the value of early postoperative bispectral index(BIS)in predicting consciousness recovery of patients with poor-grade(Hunt-Hess gradeⅥ~Ⅴ)aneurysmal subarachnoid hemorrhage(aSAH).Methods A total of 156 patients with poor-grade aSAH who underwent surgery were selected from January 2015 to December 2021.BIS values were recorded within 3 days after the operation,and the low,high and mean values of BIS were calculated.Six months after the operation,consciousness status was assessed according to GCS score,with a GCS score≥13 as consciousness recovery.Results Of these 156 patients,76 patients(recovery group)regained consciousness 6 months after the operation and 80 patients(no recovery group)did not(45 unconscious,35 death).The low,high and mean values of BIS in the recovery group were significantly higher than those in the no recovery group(P<0.01).ROC curve analysis showed that the area under the curve of low,high and mean values of BIS for predicting consciousness recovery were 0.758(95%CI 0.682~0.834),0.866(95%CI 0.808~0.924)and 0.830(95%CI 0.765~0.895),respectively.For predicting consciousness recovery,the sensitivity and specificity of BIS low value≥41 were respectively 73.7%and 67.5%,the positive and negtive predictive values were respectively 68.3%and 73.0%;the sensitivity and specificity of BIS high value≥55 were respectively 92.1%and 75.0%,the positive and negtive predictive values were respectively 77.8%and 90.9%;the sensitivity and specificity of BIS mean value≥47 were respectlvely 86.8%and 73.8%,the positive and negative predictive values were rspectively 75.9%and 85.5%.Conclusions BIS can objectively reflect the electrical activity of the brain,and can predict the recovery of consciousness of patients with poor-grade aSAH after the operation,and the prediction accuracy of BIS high value is the highest.
作者
刘健伟
程矫
甄勇
何亮
宋炳伟
耿平
胡建兵
LIU Jian-wei;CHENG Jiao;ZHEN Yong;HE Liang;SONG Bing-wei;GENG Ping;HU Jian-bing(Department of Emergency,Northern Jiangsu People's Hospital,Yangzhou 225000,China;Department of Neurosurgery,Northern Jiangsu People's Hospital,Yangzhou 225000,China)
出处
《中国临床神经外科杂志》
2023年第8期493-496,共4页
Chinese Journal of Clinical Neurosurgery
基金
扬州市社会发展基金(YZ2021089)。
