摘要：

目的 探讨短潜伏期体感诱发电位（SLSEP）和脑干听觉诱发电位（BAEP）预测急性重症脑卒中患者预后的最佳时机。方法 以Glasgow 昏迷量表（GCS）评分≤ 12分并经头部CT 和（或）MRI检查证实的幕上大面积梗死或大容积出血患者作为观察对象，分别于发病后第1 ~ 3 和4 ~ 7 天行GCS 评分、SLSEP 和BAEP 检查；并于发病后6 个月采用改良Rankin 量表（mRS）评估预后，分析发病后不同时间窗预测指标（GCS 评分、SLSEP 和BAEP）与预后评估指标（mRS 评分）之间的关联性和预测准确性。结果 （1）关联性分析：发病第1 ~ 3 天，GCS 评分、SLSEP 和BAEP 与mRS 评分之间无关联性（均P > 0.05）；发病第4 ~ 7 天，SLSEP 和BAEP 与mRS 之间存在关联性（均P < 0.01，C > 0.400）。（2）预后预测准确性分析：发病第4 ~ 7 天，SLSEP 和BAEP Ⅴ 波预测灵敏度为85.71% ~ 97.62%、BAEP 特异度为80.00% ~90.00%，各项预测指标阳性预测值达89.13% ~ 96.88%、SLSEP 阴性预测值为83.33%～85.71%，其中SLSEP 和BAEP 预测准确度均达临床预期，尤以SLSEP 最佳（88.46% ~ 90.38%）。结论 急性重症脑卒中患者发病第4 ~ 7天SLSEP 和BAEP 预测不良预后的准确性较高。

关键词: 卒中, 诱发电位, 躯体感觉, 诱发电位, 听觉, 脑干, 预后, 敏感性与特异性

Abstract:

Objective  To investigate the best assessment time of short-latency somatosensory-evoked potential (SLSEP) and brain stem auditory-evoked potential (BAEP) in predicting the prognosis of patients with acute severe stroke.  Methods  Fifty-two patients who were diagnosed as supratentorial massive cerebral infarction or large-volume cerebral hemorrhage by brain CT and/or MRI examination with Glasgow Coma Scale (GCS) ≤ 12 were selected as observation subjects. GCS, SLSEP and BAEP were recorded at 1-3 and 4-7 d after onset. Outcomes were examined 6 months later using the modified Rankin Scale (mRS). A mRS score of 0-4 was considered as favorable outcome while a score of 5-6 was considered as unfavorable. The correlation between different predictive indexes (GCS, SLSEP and BAEP) and outcome (mRS) was analyzed. The predictive accuracy was also analyzed.  Results  At 1-3 d after onset, there was no correlation between all the predictors and outcome (P > 0.05, for all). At 4-7 d after onset, SLSEP and BAEP were significantly correlated with mRS (P < 0.01, for all; C > 0.400). At 4-7 d after onset, the prognostic sensitivity of SLSEP and BAEP Ⅴ wave was 85.71%-97.62% ; prognostic specificity of BAEP was 80.00%-90.00%; positive predictive value of all predictors was 89.13%-96.88%; negative predictive value of SLSEP was 83.33%-85.71% ; total predictive accuracy of SLSEP was 88.46%-90.38%. The predictive accuracy of both SLSEP and BAEP achieved the clinical expectation, and the former is better than the latter.  Conclusions  SLSEP and BAEP have a high accuracy rate in predicting the unfavorable prognosis of patients with acute severe stroke 4-7 d after onset. 

Key words: Stroke, Evoked potentials, somatosensory, Evoked potentials, auditory, brain stem, Prognosis, Sensitivity and specificity