| Conscious disturbance is a clinical manifestation of the cerebral cortex and/or the brain stem’s upward reticular activation system with different degrees of damage or dysfunction,which varies with changes in brain function.Common conscious disturbances include decreased levels of awakening and changes in consciousness.The conscious disturbances caused by various causes have a high incidence in the Pediatric intensive care unit(PICU).Early identification and assessment of brain injury,early detection of reversible brain injury,and improvement of long-term prognosis are important in the diagnosis and treatment of PICU.At present,there are many methods for clinical brain function monitoring and evaluation.The common ones are video electroencephalography(vEEG),Glasgow Coma Score(GCS),serum brain injury marker S100β protein,neuron specific enolase,neuroimaging examination and other methods,each method has advantages and disadvantages.In recent years,amplitude-integrated electroencephalography(aEEG),as a rapidly developing new brain function monitoring method,has been widely used in the neonatal field and adult departments,and it can be complementary to other brain injury diagnostic equipment to a large extent improves the accuracy of early identification and prognosis of brain function in critically ill patients.At present,the clinical application of aEEG in the field of children has not been widely developed,and the difference between aEEG and vEEG,GCS,S100β protein,NSE and other brain function monitoring methods in evaluating the prognostic value of brain function in children with conscious disturbance is still unclear.This study analyzed and compared aEEG and vEEG,improved GCS score,peripheral blood S100βprotein and NSE levels in children with consciousness disturbance,and assessed the relationship between the estimated prognosis and actual prognosis of children with different degrees of conscious disturbance through monitoring and evaluation of brain function,so as to provide reference for the clinical application of aEEG in children with severe diseases.ObjectiveTo explore the clinical application value of aEEG in evaluating brain function prognosis,and to provide clinical reference for early recognition and prognosis assessment of brain function impairment.MethodsFrom October 2018 to September 2019,100 children with different levels of conscious disturbance were admitted to PICU in the Third Affiliated Hospital of Zhengzhou University,63 males and 37 females,the oldest was 14 years old,the youngest was 1 month,and 62 cases was≤1 year old,19 cases were 1 to 3 years old,9 cases were 3 to 6 years old,and 10 cases were 6 to 14 years old.All patients completed aEEG and vEEG monitoring(monitoring time≥6 hours),improved GCS score,peripheral blood S100β protein and NSE detection within 48 hours of admission,and evaluated the prognosis based on the monitoring results.Taking the 6-month onset or clinical death as the study endpoint,the actual prognosis of the children was recorded by telephone follow-up based on the Pediatric cerebral performance category score(PCPC).Use the receiver operating characteristic curve(ROC)to analyze and compare the clinical efficacy of aEEG,vEEG,improved GCS score,S100β protein,and NSE in evaluating the prognosis of brain function in children with conscious disturbance,Kappa consistency test was used to evaluate the correlation between estimated prognosis and actual prognosis.Results1.There were no follow-up loss or withdrawal in 100 conscious disturbance children in this clinical study,including 28 cases of intracranial infection(28.0%),17 cases of septic encephalopathy(17.0%),14 cases of epilepsy(14.0%),13 cases of hypoxic-ischemic encephalopathy(13.0%),9 cases of intracranial hemorrhage(9.0%),8 cases of genetic metabolic diseases(8.0%),5 cases of diabetic ketoacidosis(5.0%),4 cases of primary brain injury(4.0%),1 case of intracranial space occupying(1.0%).2.Constructing ROC curves of aEEG,vEEG,improved GCS,S100β protein and NSE,and calculate the Youden Index to get the best cutoff value。Using the best cut-off value as the gold standard for evaluating prognosis,aEEG had the highest sensitivity to evaluate poor prognosis(90.5%),the area under the curve were 0.847,0.810,0.729,0.685 and 0.784,respectively,which were statistically significant in evaluating the prognosis of brain function(P<0.05).Using the Z value as the gold standard,there was a significant difference in the clinical efficacy of aEEG compared with S100β in evaluating poor prognosis of brain function,and the analysis was statistically significant(Z>1.96,P<0.05),but with no significant difference compared with the other three methods.3.By constructing ROC curve,Use the best cutoff value as the criterion for assessing prognosis,aEEG,vEEG,improved GCS,S100β protein and NSE were used to evaluate the brain function prognosis,good prognosis were 43(43.0%),45(45.0%),55(55.0%),80(80.0%)and 55(55.0%),respectively;poor prognosis were 57(57.0%),55(55.0%),45(45.0%),20(20.0%)and 45(45.0%),respectively.With PCPC as the actual prognostic criteria,the actual prognosis was good in 58 patients(58.0%)and poor in 42 patients(42.0%).Tested by Kappa consistency,the aEEG assessed prognosis was consistent with the actual prognosis by Kappa consistency test(Kappa=0.550,α=0.000).ConclusionsAmplitude-integrated electroencephalography(aEEG)has a good evaluation value for the brain function prognosis of children with conscious disturbance,It has high sensitivity and is consistent with the actual clinical prognosis.It can be widely used in the diagnosis and treatment of PICU. |
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