Liu Hua,Hu Jihong,He Jinhua,et al.Characteristics and prognostic value of somatosensory evoked potentials in children with disorder of consciousness during convalescence of severe brain injury[J].Journal of Clinical Pediatric Surgery,2023,22(06):538-543.[doi:10.3760/cma.j.cn101785-202208001-008]
重症脑损伤恢复期意识障碍患儿体感诱发电位特点及其对预后的判断价值
- Title:
- Characteristics and prognostic value of somatosensory evoked potentials in children with disorder of consciousness during convalescence of severe brain injury
- Keywords:
- Brain Injuries; Consciousness Disorders; Neurophysiological Monitoring; Diagnosis; Prognosis; Child
- 摘要:
- 目的 探讨重症脑损伤恢复期意识障碍[包括最小意识状态（minimally conscious state，MCS）和植物状态（vegetative state，VS）]患儿体感诱发电位（somatosensory evoked potential，SEP）的特点及其对预后的判断价值。方法 本研究为回顾性研究，收集2017年11月至2021年10月于湖南省儿童医院康复中心接受住院康复治疗的51例重症脑损伤恢复期意识障碍患儿临床资料，其中MCS 24例，VS 27例。患儿均于入院48 h内完成意识水平评估及SEP检查，意识水平的评估采用改良昏迷恢复量表（coma recovery scale-revised，CRS-R）评分，根据CRS-R评分将患儿结局分为意识清楚、未恢复意识。以发病后满6个月为研究截止时间。根据患儿意识状态水平分为最小意识状态组（MCS组）和植物状态组（VS组）；根据患儿脑损伤病因分为脑外伤组、脑炎组和缺血缺氧性脑病组；根据Judson分级标准对SEP检查结果进行分级，将患儿分为SEP Ⅰ级组、Ⅱ级组、Ⅲ级组，其中Ⅰ级为正常组，Ⅱ级、Ⅲ级为异常组。收集并分组统计分析各组患儿意识恢复情况以及SEP特点。结果 至研究截止时，51例患儿中30例意识转清楚，21例未恢复意识，意识恢复率为58.82%（30/51），无一例死亡。MCS组SEP分级好于VS组，但差异无统计学意义（P>0.05）；MCS组意识恢复率（19/24，79.17%）高于VS组（11/27，40.74%），差异有统计学意义（P<0.05）。不同病因组患儿SEP分级比较，脑外伤组SEP分级最差（Ⅰ级、Ⅱ级、Ⅲ级患儿例数分别为2例、2例、14例），差异有统计学意义（P<0.05）；不同病因组患儿意识恢复率比较，脑外伤组（13/18）>脑炎组（10/16）>缺血缺氧性脑病组（7/17），但三组差异无统计学意义（P>0.05）。不同SEP分级患儿意识恢复率比较，差异有统计学意义（P<0.05），SEP正常患儿的意识恢复率（14/17）明显高于SEP异常患儿（16/34），差异有统计学意义（P<0.05）。将CRS-R评分作为判断患儿神志是否清楚的金标准，SEP异常对重症脑损伤恢复期意识障碍患儿意识恢复评估的灵敏度、特异度、准确性分别为85.71%（18/21）、46.67%（14/30）、62.75%（32/51）。结论 重症脑损伤恢复期意识障碍患儿SEP异常与其意识恢复具有相关性，对意识障碍患儿意识恢复及预后的判断具有一定的应用价值。
- Abstract:
- Objective To explore the characteristics and prognostic values of somatosensory evoked potential (SEP) in children with disorder of consciousness during convalescence of severe brain injury, including minimal consciousness state (MCS) and vegetative state (VS).Methods From November 2017 to October 2021, clinical data were reviewed for 51 children with disorder of consciousness during convalescence of severe brain injury on inpatient rehabilitation treatment.24 cases were MCS and 27 cases were VS.All of them completed consciousness level assessments and SEP examination within 48 h after admission.Consciousness level was assessed by coma recovery scale-revised (CRS-R) and the outcomes were divided into clear consciousness and unregained consciousness.The deadline was at least 6 months after an onset of the disease.Based upon consciousness level, they were divided into two groups of MCS (n=24) and VS (n=27);according to different etiologies, three groups of traumatic brain injury, encephalitis and hypoxic ischemic encephalopathy were assigned.The SEP examination results were graded according to the Judson grading criteria.Grade Ⅰ was normal and grade Ⅱ/Ⅲ abnormal. Results At Month 6 post-onset, 30/51 cases regained consciousness while the remainders failed to recover consciousness.The consciousness recovery rate was 58.82%(30/51) and no death occurred.SEP grading of MCS group was better than that of VS group.However, the difference was not statistically significant (P>0.05).The recovery rate of consciousness was higher in MCS group (19/24, 79.17%) than that in VS group (11/27, 40.74%).And the difference was statistically significant (P<0.05).Statistically significant difference rxisted in the classification of SEP among three groups with different etiologies (P<0.05).SEP grading of traumatic brain injury group was the worst (2 cases of grade Ⅰ, 2 cases of grade Ⅱ, 14 cases of grade Ⅲ, respectively).Comparison of consciousness recovery rate among three groups with different etiologies:traumatic brain injury group (13/18) > encephalitis group (10/16) > hypoxic ischemic encephalopathy group (7/17).However, no significant difference existed among three groups (P>0.05).The difference in consciousness recovery rate was statistically significant among children with different SEP grades (P<0.05).The consciousness recovery rate of children with normal SEP (14/17) was significantly higher than that of children with abnormal SEP (16/34) and the difference was statistically significant (P<0.05).Using CRS-R as a gold standard for judging whether or not consciousness was lucid, the sensitivity, specificity and accuracy of SEP abnormality in assessing consciousness recovery in children with disorder of consciousnessin convalescence of severe brain injury were 85.71%(18/21), 46.67%(14/30) and 62.75%(32/51) respectively. Conclusion In children with disorder of consciousness during convalescence of severe brain injury, abnormal SEP is correlated with their consciousness recovery.Thus it has some application values in judging the consciousness recovery and prognosis of children with disorder of consciousness.
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备注/Memo
收稿日期:2022-08-01。
基金项目:湖南省卫生健康委科研计划课题（202106041218）；湖南省残疾人康复科研项目（2021XK0308）
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