急性大面积脑梗死脑电图δ/α功率比值与中线结构移位的相关性研究

doi:10.3969/j.issn.1673-5765.2020.08.009

摘要/Abstract

摘要：

目的评估急性大面积脑梗死患者定量脑电图（quantitative electroencephalography，qEEG）参数和脑中线结构移位之间的相关性，探索反映脑中线结构移位最敏感的qEEG变化区域。方法纳入2017年9月-2019年5月于首都医科大学附属北京天坛医院神经重症医学科住院治疗，脑梗死体积＞患侧大脑中动脉流域的2/3，发病7 d内完成脑电图监测的脑梗死患者。使用快速傅里叶变换分别计算梗死侧和健侧的前、中、后区域以及半球脑电图的δ/α功率比值（delta/alpha power ratio，DAR），并记录同期GCS评分、NIHSS评分。在脑电图监测前后4 h内完成头颅CT或MRI，测量透明隔水平的大脑中线结构移位。统计不同区域的DAR与中线结构移位的相关性。根据中线结构移位 ≥5 mm和<5 mm，≥10 mm和<10 mm分组，比较组间不同部位DAR的差异。绘制ROC曲线，确定提示中线结构移位≥5 mm和≥10 mm的DAR界值及其敏感性和特异性，并与NIHSS评分、GCS评分对中线结构移位预测价值比较。结果共29例患者、38段脑电图记录纳入分析。健侧后头部DAR与中线结构移位正相关（ρ=0.5264， P =0.0007）。中线结构移位≥5 mm组相比<5 mm组、≥10 mm组相比<10 mm组，健侧后头部DAR均显著升高（分别为6.48±5.70 vs 2.09±1.47，P =0.0043；10.59±6.60 vs 3.29±3.30，P =0.0008）。分别以DAR≥2.326和≥2.569为界值，可以提示中线结构移位≥5 mm和≥10 mm（敏感度分别为72.73%和 100.00%，特异度分别为81.25%和64.52%），均优于NIHSS评分和GCS评分。结论健侧后头部DAR增加与大面积脑梗死中线结构移位呈正相关。qEEG可作为监测大面积脑梗死中线结构移位的方法。

文章导读： 通过对急性大面积脑梗死患者EEG的回顾性分析发现健侧后头部qEEG指标DAR可以反映患者中线结构移位，该指标优于NIHSS评分和GCS评分。

关键词: 定量脑电图; 大面积脑梗死; 中线结构移位; δ /α 功率比值

Abstract:

Objective To determine the association between quantitative electroencephalography (qEEG) parameters and midline shift in patients with malignant middle cerebral artery (MCA) infarction. Methods This retrospective analysis enrolled the patients with unilateral ischemic changes that affected two-thirds or more of MCA territory and who underwent EEG monitoring within seven days after stroke onset from Neurocritical Care Unit of Beijing Tiantan Hospital between 2017 September and 2019 May. The δ/α ratios (delta/alpha power ratio, DAR) of anterior, middle and posterior hemispheric regions of infarct side and non-infarct side were calculated using fast Fourier transformation. The baseline GCS and NIHSS score and other clinical data were collected. The brain midline structure shift was measured based on CT or MRI that was performed within four hours before and/or after the EEG monitoring. The association between the DAR and midline shift was analyzed. The data were also stratified into midline shift ≥5 mm and <5 mm, ≥10 mm and <10 mm, to compare the DARs of different regions. The cut-off point of DAR of specified regions for midline shift ≥5 mm or ≥10 mm were identified using ROC curve analysis. Results A total of 38 EEG records from 29 patients were analyzed. The DAR of posterior hemisphere of non-infarct side was significantly associated with midline shift (ρ =0.5264, P =0.0007). The DAR of posterior hemisphere of non-infarct side was higher in the group of midline shift <5 mm compared to the group of ≥5 mm (6.48±5.70 vs 2.09±1.47, P =0.0043), and so was in the midline shift of 10 mm stratification groups (10.59±6.60 vs 3.29±3.30, P =0.0008). In posterior hemisphere of non-infarct side, DAR ≥2.326 and ≥2.569 could suggest the midline shift ≥5 mm and ≥10 mm, with a sensitivity of 72.73% and 100.00%, a specificity of 81.25% and 64.52%, respectively. Conclusions An increase in DAR of posterior hemisphere of non-infarct side was positively correlated with midline shift caused by malignant MCA infarction. DAR could serve as a better marker for monitoring the midline shift.

Key words: Quantitative electroencephalography; Large hemispheric infarction; Midline shift;δ/α power ratio

张哲，刘大成，刘婧伊，田佳，濮月华，刘丽萍. 急性大面积脑梗死脑电图δ/α功率比值与中线结构移位的相关性研究[J]. 中国卒中杂志, 2020, 15(08): 869-875.

参考文献

[1] HACKE W，SCHWAB S，HORN M，et al.

'Malignant' middle cerebral artery territory infarction：

clinical course and prognostic signs[J]. Arch Neurol，

1996，53（4）：309-315.

[2] CLAASSEN J，VELAZQUEZ A，MEYERS E，et

al. Bedside quantitative electroencephalography improves assessment of consciousness in comatose

subarachnoid hemorrhage patients[J]. Ann Neurol，

2016，80（4）：541-553.

[3] CLAASSEN J，HIRSCH L J，KREITER K T，et al.

Quantitative continuous EEG for detecting delayed

cerebral ischemia in patients with poor-grade

subarachnoid hemorrhage[J]. Clin Neurophysiol，

2004，115（12）：2699-2710.

[4] FINNIGAN S，WONG A，READ S. Defining

abnormal slow EEG activity in acute ischaemic

stroke：delta/alpha ratio as an optimal QEEG

index[J]. Clin Neurophysiol，2016，127（2）：1452-

1459.

[5] FINNIGAN S P，ROSE S E，CHALK J B. Rapid

EEG changes indicate reperfusion after tissue

plasminogen activator injection in acute ischaemic

stroke[J]. Clin Neurophysiol，2006，117（10）：2338-

2339.

[6] FINNIGAN S，VAN PUTTEN M J A M. EEG in

ischaemic stroke：quantitative EEG can uniquely

inform（sub-）acute prognoses and clinical

management[J]. Clin Neurophysiol，2013，124（1）：

10-19.

[7] SHEIKH N，WONG A，READ S，et al. QEEG may

uniquely inform and expedite decisions regarding

intra-arterial clot retrieval in acute stroke[J]. Clin

Neurophysiol，2013，124（4）：1913-1914.

[8] PULLICINO P M，ALEXANDROV A V，

SHELTON J A，et al. Mass effect and death from

severe acute stroke[J]. Neurology，1997，49（4）：

1090-1095.

[9] JORDAN K G. Emergency EEG and continuous

EEG monitoring in acute ischemic stroke[J]. J Clin

Neurophysiol，2004，21（5）：341-352.

[10] TORBEY M T，BÖSEL J，RHONEY D H，et al.

Evidence-based guidelines for the management of

large hemispheric infarction：a statement for health

care professionals from the Neurocritical Care

Society and the German Society for Neuro-intensive

Care and Emergency Medicine[J]. Neurocrit Care，

2015，22（1）：146-164.

[11] AKINS P T，AXELROD Y V，ARSHAD S T，et

al. Initial conservative management of severe

hemispheric stroke reduces decompressive

craniectomy rates[J]. Neurocrit Care，2016，25（1）：

3-9.

[12] 徐锋，周炳华，李勇，等. 治疗大面积脑梗死的术

式选择与疗效[J]. 中华神经医学杂志，2004，3（2）：

128-129.

[13] BURGHAUS L，HILKER R，DOHMEN C，et al.

Early electroencephalography in acute ischemic

stroke：prediction of a malignant course?[J]. Clin

Neurol Neurosurg，2007，109（1）：45-49.

[14] 杨庆林，宿英英. 急性大面积脑梗死的脑电图

RAWOD模式的应用价值[J]. 中华神经科杂志，2007，

40（1）：8-10.

[15] SHREVE L，KAUR A，VO C，et al.

Electroencephalography measures are useful for

identifying large acute ischemic stroke in the

emergency department[J]. J Stroke Cerebrovasc Dis，

2019，28（8）：2280-2286.

[16] JIANG M D，SU Y Y，LIU G，et al. Predicting the

non-survival outcome of large hemispheric infarction

patients via quantitative electroencephalography：

superiority to visual electroencephalography and

the Glasgow coma scale[J/OL]. Neurosci Lett，2019，

706：88-92[2019-11-23]. https：//doi.org/10.1016/j.

neulet.2019.05.007.