振幅整合脑电图联合全面无反应性量表对意识障碍患儿预后的评价

Value of amplitude-integrated EEG combined with Full Outline of Unresponsiveness in evaluating the prognosis of children with disturbance of consciousness

摘要:

目的 研究振幅整合脑电图（aEEG）、全面无反应性量表（FOUR）、格拉斯哥昏迷评分（GCS）对儿童重症监护室（PICU）意识障碍患儿的预后评价作用。方法 选择苏州大学附属儿童医院PICU 164例意识障碍患儿为研究对象，根据预后分为预后不良组（n=111）和预后良好组（n=53）。收集两组患儿入院第1天及第5天的aEEG、FOUR及GCS结果，分析不同评估方法与预后之间的关系，采用受试者工作特征曲线评估aEEG、FOUR、GCS对预后的预测作用。结果 第5天aEEG无改善或异常程度加重者，预后较差。aEEG与预后呈正相关（r=0.698，P < 0.001），FOUR、GCS与预后呈负相关（分别r=-0.655、-0.554，P < 0.001）。aEEG、FOUR、GCS的曲线下面积（AUC）分别为0.894、0.903、0.840，3者的AUC差异无统计学意义（P > 0.05）；aEEG联合FOUR的AUC为0.945，高于各单项指标预测的AUC（P < 0.05）。结论 aEEG及FOUR均可作为预测意识障碍患儿预后的有效工具，二者联合应用可提高预测价值。

Abstract:

Objective To study the value of amplitude-integrated EEG (aEEG), Full Outline of Unresponsiveness (FOUR), and Glasgow Coma Scale (GCS) in evaluating the prognosis of children with disturbance of consciousness in the pediatric intensive care unit (PICU). Methods A total of 164 children with disturbance of consciousness who were admitted to the PICU of Children's Hospital Affiliated to Soochow University were enrolled as subjects. According to prognosis, they were divided into a poor prognosis group with 111 children and a good prognosis group with 53 children. The results of aEEG monitoring, FOUR score, and GCS score on days 1 and 5 of admission were collected. The association between evaluation methods and prognosis was analyzed. The receiver operating characteristic (ROC) curve was used to evaluate the value of aEEG, FOUR, and GCS in predicting prognosis. Results The children with no improvement or abnormal aggravation of aEEG on day 5 tended to have a poor prognosis. The results of aEEG was positively correlated with prognosis (r=0.689, P < 0.001), and FOUR and GCS were negatively correlated with prognosis (r=-0.655 and -0.554 respectively, P < 0.001). The areas under the ROC curve (AUC) of aEEG, FOUR, and GCS were 0.894, 0.903, and 0.840 respectively, and there was no significant difference in the AUC between the three indices (P > 0.05), while aEEG combined with FOUR had an AUC of 0.945, which was significantly larger than that of each index alone (P < 0.05). Conclusions Both aEEG and FOUR can be used as effective tools to predict the prognosis of children with disturbance of consciousness, and a combination of aEEG and FOUR can improve the predictive value.