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目的探讨持续床旁脑电监测技术(CEEG)对重症医学科(ICU)重度妊娠期高血压疾病患者脑功能监测的临床价值。方法采用前瞻性研究方法,选取2013年9月-2014年6月入住该院ICU的符合入选标准的患者23例为研究对象,按照国际标准10/20系统放置电极,采用FP1-A1、FP2-A2、F3-A1、F4-A2、C3-A1、C4-A2、P3-A1、P4-A2、O1-A1、O2-A2、F7-A1、F4-A2、T3-A1、C4-A2、T5-A1和P4-A2等16个导联描记,连续监测时间不少于6 h,同时结合Glasgow昏迷评分(GCS)评分、APACHE-Ⅱ评分、影像学资料及临床预后来分析CEEG的临床价值。结果 23例患者脑电监测结果Ⅰ级脑电图5例、Ⅱ级脑电图4例、Ⅲ级脑电图5例、Ⅳ级脑电图7例、Ⅴ级脑电图2例;CEEG分级与GCS评分呈负相关(r=-0.944,P<0.001),CEEG分级与APACHE-Ⅱ评分呈正相关(r=0.824,P<0.001);脑电图良好组,预后不良1例,占11.11%,脑电图不良组,预后不良3例,占21.42%,两组预后不良比例比较,差异有统计学意义(P=0.012)。结论对ICU重度妊娠期高血压疾病患者实行CEEG可准确评估患者病情严重程度、评价治疗反应及预后;结合影像学检查结果,即脑功能和形态学改变,对进一步准确评价重度妊娠期高血压疾病患者中枢神经系统功能和预后具有重要的临床价值。
Objective To investigate the clinical value of continuous bedside electroencephalography (CEEG) in the monitoring of brain function in patients with severe gestational hypertension in intensive care unit (ICU). Methods According to the prospective study, 23 eligible patients admitted to the ICU from September 2013 to June 2014 were selected as study subjects. Electrodes were placed in accordance with the international standard 10/20 system. FP1-A1 and FP2- A2, F3-A1, F4- A2, C3- A1, C4- A2, P3- A1, P4- A2, O1- A1, O2- A2, F7- A1, F4- A2, T5-A1 and P4-A2 were recorded in 16 leads. The continuous monitoring time was not less than 6 h, and the clinical value of CEEG was analyzed according to Glasgow Coma Scale (GCS), APACHE-Ⅱ score, imaging data and clinical prognosis . Results Among the 23 cases, there were 5 grade Ⅰ electroencephalogram, 4 grade Ⅱ electroencephalogram, 5 grade Ⅲ electroencephalogram, 7 grade Ⅳ electroencephalogram and 2 grade Ⅴ electroencephalogram. The CEEG grade Negatively correlated with GCS score (r = -0.944, P <0.001). There was a positive correlation between CEEG grade and APACHE-Ⅱ score (r = 0.824, , Poor electroencephalogram group, poor prognosis in 3 cases, accounting for 21.42%, poor prognosis ratio between the two groups, the difference was statistically significant (P = 0.012). Conclusions The CEEG in patients with severe pregnancy-induced hypertension in intensive care unit (ICU) can accurately evaluate the severity of the disease and evaluate the response and prognosis of the patients. Combined with the imaging findings, that is, brain function and morphological changes, CEEG can be used to further accurately evaluate the severity of hypertensive disorders Patients with central nervous system function and prognosis have important clinical value.