摘要：

目的: 探讨定量脑电图对急性缺血性卒中血管内机械取栓术后神经功能预后的预测价值。方法: 纳入2021年4月至2022年9月在河南省人民医院行血管内机械取栓术的71例急性缺血性卒中患者，术后均行定量脑电图监测，术后90 d采用改良Rankin量表（mRS）评价神经功能预后，单因素和多因素Logistic回归分析筛查术后神经功能预后不良危险因素，绘制受试者工作特征（ROC）曲线评价筛选出的危险因素预测术后神经功能预后不良的效能。结果: 预后不良组（mRS评分3~5分，28例）入院时美国国立卫生研究院卒中量表（NIHSS）评分（t=2.686，P=0.009）、取栓次数> 3次比例（χ²=4.201，P=0.040）、患侧脑电图慢波化指数（DTABR；t=2.183，P=0.032）、患侧DTABR/健侧DTABR比值（t=6.230，P=0.000）、术后即刻脑梗死溶栓血流分级 < 2b级比例（χ²=5.420，P=0.020）均高于预后良好组（mRS评分0~2分，43例）。Logistic回归分析显示，入院时高NIHSS评分（OR=1.542，95%CI：1.368~1.725；P=0.012）、高患侧DTABR/健侧DTABR比值（OR=3.428，95%CI：2.673~7.314；P=0.008）、相对α变异性（PAV）Ⅱ级（OR=2.983，95%CI：2.625~4.682；P=0.003）和Ⅲ级（OR=4.088，95%CI：3.825~5.349；P=0.002）、振幅整合脑电图（aEEG）Ⅱ级（OR=2.536，95%CI：1.942~5.287；P=0.005）和Ⅲ级（OR=3.924，95%CI：2.012~6.378；P=0.003）是急性缺血性卒中机械取栓术后预后不良的危险因素。ROC曲线显示，入院时NIHSS评分、患侧DTABR/健侧DTABR比值、PAV分级、aEEG分级及其联合指标预测急性缺血性卒中机械取栓术后预后不良的曲线下面积分别为0.676（95%CI：0.554~0.782，P=0.000）、0.887（95%CI：0.789~0.950，P=0.000）、0.760（95%CI：0.643~0.853，P=0.000）、0.778（95%CI：0.664~0.868，P=0.000）和0.943（95%CI：0.861~0.984，P=0.000）。其中，联合指标的预测效能高于单独应用入院时NIHSS评分（Z=4.150，P=0.000）、PAV分级（Z=4.006，P=0.000）和aEEG分级（Z=3.462，P=0.001）。结论: 定量脑电图对早期预测急性缺血性卒中血管内机械取栓术后神经功能预后具有重要应用价值。

关键词: 缺血性卒中, 机械溶栓, 脑电描记术, 危险因素, Logistic模型, ROC曲线

Abstract:

Objective: To explore the clinical application of quantitative electroencephalography (qEEG) in predicting the early prognosis of acute ischemic stroke after mechanical thrombectomy. Methods: A total of 71 patients who underwent acute ischemic stroke mechanical thrombectomy from April 2021 to September 2022 were enrolled in He'nan Provincial People's Hospital, all of them performed qEEG after surgery. Modified Rankin Scale (mRS) was used to evaluate the prognosis on the 90 d after the surgery. Univariate and multivariate backward Logistic regression analyses were used to screen risk factors for prognosis in acute ischemic stroke after mechanical thrombectomy. Receiver operating characteristic (ROC) curve was used to predict the value of qEEG for the prognosis of neural function. Results: Patients in dismal prognosis group (mRS score 3-5, n=28) had higher NIHSS score at admission (t=2.686, P=0.009), higher proportion of thrombectomy performed more than 3 times (χ²=4.201, P=0.040), higher values of DTABR on the affected side (t=2.183, P=0.032), higher ratio of DTABR on affected side/unaffected side (t=6.230, P=0.000), and higher proportion of immediately Thrombolysis in Cerebral Infarction (TICI) < 2b after surgery (χ²=5.420, P=0.020) compared to favorable prognosis group (mRS score 0-2, n=43). Logistic regression analysis showed higher NIHSS score at admission (OR=1.542, 95%CI: 1.368-1.725; P=0.012), DTABR on affected side/unaffected side (OR=3.428, 95%CI: 2.673-7.314; P=0.008), percent alpha variability (PAV) grade Ⅱ (OR=2.983, 95%CI: 2.625-4.682; P=0.003) and grade Ⅲ (OR=4.088, 95%CI: 3.825-5.349; P=0.002), amplitude electroencephalography (aEEG) grade Ⅱ (OR=2.536, 95%CI: 1.942-5.287; P=0.005) and grade Ⅲ (OR=3.924, 95%CI: 2.012-6.378; P=0.003) were risk factors of dismal prognosis in acute ischemic stroke after mechanical thrombectomy. ROC curve showed the area under the curve (AUC) of NIHSS score was 0.676 (95%CI: 0.554-0.782, P=0.000), DTABR on affected side/unaffected side was 0.887 (95%CI: 0.789-0.950, P=0.000), the PAV was 0.760 (95%CI: 0.643-0.853, P=0.000), aEEG was 0.778 (95%CI: 0.664-0.868, P=0.000), and the combined indicators classification was 0.943 (95%CI: 0.861-0.984, P=0.000). Among them, the predictive power of the combined indicators is higher than that of the NIHSS score at admission (Z=4.150, P=0.000), PAV (Z=4.006, P=0.000) and aEEG (Z=3.462, P=0.001). Conclusions: qEEG is an effective method to predict the early prognosis of acute ischemic stroke after mechanical thrombectomy.

Key words: Ischemic stroke, Mechanical thrombolysis, Electroencephalography, Risk factors, Logistic models, ROC curve