| Background and ObjectiveDisturbance of consciousness(DOC)is a common clinical symptom after severe craniocerebral injury.In recent years,there are more than 500,000 patients with disturbance of consciousness caused by craniocerebral injury in China,with an annual growth rate of about 70?100000,which brings great mental pressure and economic burden to the family and society.Coma is the most serious disturbance of consciousness.Patients in a coma may die,fully regain consciousness,or evolve into intermediate states such as unresponsive arousal syndrome/vegetative state(UWS/VS)or micro(minimum,lowest)consciousness(MCS).These patients are unable to communicate and develop severe motor disorders,loss of sensation,language disorders and alert fluctuations.At present,it is recognized that the method of evaluating coma is Glasgow coma scale,which is divided into eye opening response,body movement response and speech response.The revised coma recovery scale(CRS-R)is an internationally recognized scale for evaluating the level of disturbance of consciousness,which assesses auditory,visual,sensory,motor and communication responses,and can sensitively reflect the changes of patients' conditions.However,due to the subjectivity of clinical evaluation,it may lead to a high misdiagnosis rate.The gradually developed electrophysiological examinations such as EEG and event-related potential(ERP)have objectivity and high time resolution,and have certain advantages in the evaluation of patients with disturbance of consciousness.The factors that affect the prognosis of coma patients with brain injury are complex and diverse.there is a lack of objective and reliable criteria to evaluate the level of consciousness of coma patients when they evolve into vegetative state or micro-consciousness state.In this paper,we studied the clinical factors affecting the prognosis of coma patients with brain injury and the evaluation of the level and prognosis of patients with disturbance of consciousness after brain injury.EEG examination combined with clinical multivariate analysis was used to establish a model to predict the prognosis of coma patients after brain injury.The event-related potentials MMN and P300 derived from EEG were used to examine the electrophysiology of MMN and P300 in patients with disturbance of consciousness,to analyze the potential changes of MMN and P300 in patients with different levels of disturbance of consciousness,and to explore the predictive value of prognosis,so as to provide a simple and effective method for evaluating and predicting whether patients can wake up.Chapter One Analysis of multiple factors affectingthe prognosis of coma patients after brain injuryMethodsThe clinical data of 168 coma patients after craniocerebral injury treated in the Department of Neurosurgery of the Fifth affiliated Hospital of Zhengzhou University from December 2014 to March 2017 were included retrospectively.the information included sex,age,type of brain injury,admission GCS score,bilateral pupil light reflex and size,serum electrolyte level and the results of video-EEG examination.The patients were followed up for 3 months..Univariate and multivariate analysis were used to evaluate the relationship between predictors and prognosis.Results1.Among the 168 coma patients with craniocerebral injury,116(69.0%)had a good prognosis and 52(31.0%)had a poor prognosis during the follow-up period of this study.2.Univariate analysis of sex and age on the prognosis of coma patients,byx2 test,P>0.05,there was no statistical difference.GCS score,bilateral pupil condition,bilateral pupil reflex,electrolyte imbalance and EEG grade were compared with the prognosis of coma patients.By?2 test,P<0.05,there was statistical significance.3.Multivariate analysis showed that GCS score,bilateral pupil reflex,electrolyte imbalance and EEG grade were important factors affecting the prognosis of coma patients with brain injury(P<0.05).4.The discriminant effect of the regression model according to the regression model established in this study,the probability of good prognosis of coma patients with brain injury after treatment was predicted.With the prediction probability of 0.5%as the cut-off point,the total correct rate was 97.6%.Conclusion1.GCS score,bilateral pupil light reflex,electrolyte imbalance and EEG grade are significant factors affecting the prognosis of coma patients after brain injury.These factors are risk factors.2.The regression model established in this study can provide a relatively simple method for early evaluation and prediction of the prognosis of coma patients after brain injury,and assist clinicians in clinical decision-making.Chapter Two A study of event-related potentials MMN and P300 in evaluating the level and prognosis of patients with disturbance of consciousness after brain injuryMethodsThe patients with disturbance of consciousness treated in the Department of Neurosurgery of the Fifth affiliated Hospital of Zhengzhou University from December 2017 to March 2019 were retrospectively included as the study group,and 20 healthy volunteers who came to the hospital for physical examination were selected as the control group.The GCS and LOC scores of the patients were first recorded when they were admitted to the hospital.The patients were tested after clinical treatment was stable,and the test was terminated 3 months after discharge by telephone follow-up,and the family members of the patients were asked about their state of consciousness and recovery.According to the score of consciousness level,the patients were divided into vegetative state group and minimum consciousness state group to explore the application and prognostic value of MMN and P300 in the evaluation of consciousness level of patients with disturbance of consciousness.Results1.The latency of MMN and the amplitude of MMN in the study group were significantly higher than those in the control group(t=4.97,P<0.05).The latency of P300 in the study group was significantly higher than that in the control group(t=-8.73,P<0.05),and the amplitude of P300 in the study group was significantly higher than that in the control group(t=-9.1 2,P<0.05).2.The latency of MMN in VS group was longer than that in MCS group,that in VS group was longer than that in normal control group,that in MCS group was longer than that in normal control group(P<0.05),that of P300 in VS group was longer than that in MCS group,that in VS group was longer than that in normal control group,that in MCS group was longer than that in normal control group(P<0.05,the difference was statistically significant).The amplitude of MMN in VS group was lower than that in MCS group,that in VS group was lower than that in normal control group,that in MCS group was lower than that in normal control group(P<0.05),that of P300 in VS group was lower than that in MCS group,that in VS group was lower than that in normal control group,that in MCS group was lower than that in normal control group(P<0.05,the difference was statistically significant).3.When the MMN amplitude was used to predict the patient's MCS outcome,the area under the ROC curve was equal to 0.94,and the MMN amplitude 1.72?V was the best critical value,with a sensitivity of 89%and a specificity of 75%.When the P300 amplitude was used to predict the outcome of MCS patients,the area under the ROC curve was equal to 0.99,and the P300 amplitude 1.84?V was the best critical value,with a sensitivity of 100%and a specificity of 78%.4.The sensitivity,specificity,accuracy and error rate of P300 in the prognosis of patients with disturbance of consciousness were better than those of MMN(P<0.05).The sensitivity,specificity,accuracy and error rate of MMN combined with P300 in the prognosis of patients with disturbance of consciousness were better than those of MMN/P300 alone(P<0.05).Conclusion1.The latency of MMN and P300 was prolonged and the amplitude decreased in patients with disturbance of consciousness.2.The amplitudes of MMN and P300 can predict the state of microconsciousness.3.MMN combined with P300 can more accurately and sensitively evaluate the prognosis of patients with disturbance of consciousness. |
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