To Investigate The Clinical Value Of Amplitude-integrated Electroencephalography In Postoperative Monitoring Of Patients With High Grade Aneurysmal Subarachnoid Hemorrhage

BackgroundPatients with high grade aneurysmal subarachnoid hemorrhage account for 20% to 30% of all patients with aneurysmal subarachnoid hemorrhage,and have high morbidity and mortality.The poor prognosis of high-grade aSAH is closely related to delayed cerebral infarction(DCI).However,a simple,intuitive bedside tool is still lacking in the clinic to assess the prognosis of high grade aSAH and early detection of delayed cerebral ischemia.ObjectiveTo investigate the clinical value of amplitude-integrated electroencephalography(aEEG)monitoring after high-grade aSAH surgery,including the early detection of delayed cerebral ischemia and to determine the prognosis of patients with high-grade aSAH.MethodsProspective collection of aEEG classification and clinical data of high-grade aSAH in our department from December 2016 to February 2018.Specifically,amplitude-integrated EEG is divided into the following categories: 1.Continuous normal state;2.Non-sustained normal state;3.Low-voltage state;4.Horizontal trend state.Record the time when there is an abnormal amplitude.Three months after discharge,the patient’s prognosis was evaluated using the modified RANKIN scale(mRS).0-3 points were defined as good prognosis,and 4-6 points were defined as poor prognosis.Combined with imaging studies to determine the presence of DCI and record the time of occurrence of DCI.ResultsA total of 23 patients with high-grade aSAH met the inclusion and exclusion criteria,with an average age of56.4±10.7 years,of which HUNT-HESS IV was 17(74%)and V was 6(26%).According to their follow-up prognosis: good prognosis(mRS score 0-3 points)9 cases(39%),poor(mRS score 4-6 points)14 cases(61%).There were 5 deaths(21.7%)in the poor group.In the good prognosis group,aEEG was normal in 6 cases and abnormal in 3 cases;in the poor prognosis group,0 cases were normal,and abnormal amplitude was 14 cases,P=0.001.Ten cases of delayed cerebral infarction were clearly identified by postoperative imaging.In the DCI group,there were 0 normal aEEG group and 10 abnormal amplitude group;6 cases had a normal aEEG group and 7 cases had abnormal amplitude in the DCI group.,P=0.019.The average DCI diagnosis time was 59.7±25.5 hours after surgery.The mean duration of lead-related abnormalities in the aEEG was 45.3 ± 17.4 hours.ConclusionAEEG monitoring of abnormal amplitude after high-grade aSAH can be used as a predictor of poor prognosis.The abnormality of aEEG is inextricably linked with the occurrence of DCI.However,whether early detection of DCI can provide early warning for patients needs further study to clarify.