| 张蒙,杨健全,沈文宾,尹保奇,郝汇睿,赵永红,李宏磊,李恩耀.事件相关电位联合昏迷恢复量表对意识障碍患儿预后评估的临床应用研究[J].中国康复,2023,38(2):86-90 |
| 事件相关电位联合昏迷恢复量表对意识障碍患儿预后评估的临床应用研究 |
| Clinical application of event-related potential combined with coma recovery scale in evaluating the prognosis of children with disorder of consciousness |
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| DOI： |
| 中文关键词: 意识障碍 事件相关电位 昏迷恢复量表 预后 |
| 英文关键词: disorder of consciousness event-related potential coma recovery scale prognosis |
| 基金项目:河南省自然科学基金面上项目（212300410399），河南省卫健委项目（LHGJ20190430、LHGJ20190410），郑州市协同创新重大专项（18XTZX12003） |
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| 中文摘要: |
| 目的：探讨失匹配负波（MMN）、P300检查联合昏迷恢复量表（CRS-R）在意识障碍患儿预后判断中的临床应用价值。方法：回顾性研究42例意识障碍（DOC）患儿的临床资料。记录患儿的基本资料、昏迷恢复量表修订版(CRS-R) 评分和事件相关电位（Event-Related Potential，ERP）结果。以入院后6个月、脱离MCS或死亡为研究终点，根据CRS-R评分采用床旁评估或电话随访追踪患儿预后。分别对患儿临床资料、量表及ERP指标进行单因素分析，筛选出有意义指标，对其采用二元Logistic回归分析法（逐步法-向前），建立回归模型，绘制ROC曲线，判断预后评估的价值。结果：单因素分析发现，2组患儿CRS-R 评分、失匹配负波（MMN）潜伏期与波幅、P300波幅差异均有统计学意义（P＜0.05）。多因素Logistic 回归分析发现：MMN潜伏期每增加10ms，患儿清醒的概率是原来的0. 548倍，差异具有统计学意义（OR=0.548, 95%CI 0.344-0.872, P=0.011）；MMN波幅每增加0.1uv，患儿预后清醒的概率增加0.34倍，差异具有统计学意义（OR=1.34, 95%CI 1.060-1.695, P=0.014）；P300波幅每增加0.1uv，患儿预后清醒的概率增加0.261倍（OR=1.261, 95%CI 0.986-1.612, P=0.064）；对模型进行检验，χ2=9.917，P=0.271，模型拟合效果良好。绘制ROC曲线发现，MMN潜伏期、MMN波幅与P300波幅3种方法联合所对应的AUC值最高，为0.938，P<0.001。结论：MMN潜伏期与波幅、P300波幅均与DOC患儿的预后相关，3种指标联合检测的准确率、特异性、敏感度均最高，可对DOC患儿的预后判断提供依据，有一定的临床应用价值。 |
| 英文摘要: |
| Objective: To explore the clinical value of mismatched negative wave (MMN) and P300 combined with coma recovery scale (CRS-R) in predicting the prognosis of children with disorder of consciousness（DOC）. Methods: The clinical data of 42 children with DOC were studied retrospectively. The basic data, the score of revised coma recovery scale (CRS-R) and the results of event-related potential (ERP) were recorded. The end point of the study was 6 months after admission, leaving minimally conscious state or death. The prognosis was followed up by bedside evaluation or telephone follow-up according to CRS-R score. The clinical data, scale and ERP index were analyzed by univariate analysis, and the indexes related to prognosis were screened. Binary Logistic regression analysis was used to establish a regression model, draw ROC curve, and judge the value of prognosis evaluation. Results: The univariate analysis showed that there were significant differences in CRS-R score, latency and amplitude of MMN, amplitude of P300. Multivariate Logistic regression analysis showed that for every 10 ms increase in MMN latency, the probability of awakening was 0.548 times higher than that of the original (OR=0.548, 95%CI: 0.344-0.872, P=0.011), and the probability of conscious prognosis increased 0.34 times when the amplitude of MMN increased (OR=1.34, 95%CI: 1.060-1.695, P=0.014). When the amplitude of P300 increased with 0.1 uV, the probability of clear prognosis increased by 0.261 times (OR=1.261, 95%CI: 0.986-1.612, P=0.064), and the model was tested: χ2=9.917, P=0.271, which showed a good fitting effect. By drawing the ROC curve, it was found that the AUC value of the combination of MMN latency, MMN amplitude and P300 amplitude was the highest, 0.938 (P<0.001). Conclusion: The latency and amplitude of MMN and the amplitude of P300 are related to the prognosis of children with DOC. The combined detection of the three indexes has the highest accuracy, specificity and sensitivity, which can provide a basis for judging the prognosis of children with DOC and has a certain clinical application value. |
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