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目的:探讨儿童重症监护室(pediatric intensive care unit,PICU)意识障碍患儿振幅整合脑电图的表现及其评估预后的价值。方法:152例纳入研究,采用振幅整合脑电图(amplitude-integrated EEG,a EEG)与视频脑电图(video EEG,v EEG)、改良格拉斯哥昏迷评分(Glasgow coma scale,GCS)对照研究,探索评估预后的价值。记录改良GCS评分,行至少2 h a EEG及同步16导联v EEG监测,追踪出院后3个月预后,以实际不良预后构建受试者工作特征曲线(receiver operating characteristic,ROC),对比分析3种方法预测不良预后的灵敏度、特异度、准确度。结果:正常、轻度异常、重度异常a EEG预后不良率分别为4.2%、57.7%、100%。经Kappa一致性检验,a EEG预测预后与实际预后具有一致性(P=0.000)。a EEG、v EEG、GCS评分ROC曲线下面积分别为0.939、0.908、0.926。以异常a EEG为截断值,其预测不良预后的灵敏度、特异度、准确度分别为80.0%、95.5%、86.4%。结论:a EEG背景活动对PICU意识障碍患儿预后有很好的预测价值,与v EEG、GCS评分对比无明显差异,因其具有简单客观等优点可作为PICU常规脑功能监测的方法。
OBJECTIVE: To investigate the amplitude-integrated electroencephalogram (EEG) and the value of prognostic evaluation in pediatric intensive care unit (PICU) children with impaired cognition. Methods: Fifty-two patients were included in the study. The amplitude-integrated EEG (EEG) and video EEG (EEG) were used to improve the Glasgow coma scale (GCS) Evaluate the value of the prognosis. A modified GCS score was recorded. At least 2 ha EEG and synchronized 16-lead v EEG monitoring were performed. The prognosis of 3 months after discharge was recorded. Receiver operating characteristic (ROC) was constructed based on the actual adverse prognosis. Methods To predict the sensitivity, specificity and accuracy of poor prognosis. Results: The normal and mild abnormalities and severe abnormalities were 4.2%, 57.7% and 100% respectively. The Kappa consistency test, a EEG predict prognosis and the actual prognosis was consistent (P = 0.000). The area under the ROC curve of a EEG, v EEG and GCS scores were 0.939, 0.908 and 0.926, respectively. The sensitivity, specificity and accuracy of the prediction of poor prognosis were 80.0%, 95.5% and 86.4%, respectively. CONCLUSION: a EEG background activity has a good predictive value for the prognosis of PICU children with no significant difference compared with v EEG and GCS scores. Because of its simplicity and objectiveness, it can be used as a routine monitoring method for PICU.