| Background and purposePatients with severe brain injury(stroke,brain injury,hypoxic ischemic encephalopathy,etc.)usually have consciousness disorder(Disorder of consciousness,DOC).With the development of modern medical technology,the survival rate of patients with severe craniocerebral injury is increasing,and data show that(5-250)/ 10,000 brain injury patients will develop into chronic DOC patients.The high treatment costs and complicated care put a heavy burden on DOC patients ’ families and society.Accurate evaluation of DOC is very important for both patient treatment and prognosis.At present,there are mainly clinical behavioral evaluation,imaging evaluation and the evaluation of electrophysiological methods.In general,clinical behavioral evaluation has certain subjectivity,imaging evaluation examination is expensive and not easy to bedside examination,and electrophysiological evaluation is not only economic,convenient but also easy to operate,convenient and easy to use in clinical practice.Electrophysiological assessments include EEG,evoked and event-related potentials,where event-related potential assessment best reflects the level of consciousness,with the most event-related potential clinical applications are mismatched negative waves(mismatch negative,MMN).Previous studies focused the use of MMN in subacute phases and the analysis of overall MMN data.This study mainly recorded the dynamic changes of MMN points and CRS-R scores in the course of DOC patients,explored the correlation of MMN different guides and CRS-R,and studied the predictive value of its amplitude and incubation period on the prognosis of patients with chronic DOC.MethodSubjects: from March 2020 to December 2020,the patients with consciousness disorder in the Department of Rehabilitation Medicine of Hunan Provincial people’s Hospital were divided into VS/WUS group and MCS group by CRS-R score.A normal control group with 14 healthy people was set up.Data acquisition: on the day of admission or the next day,the NSM1 type of EEG-event-related potential monitor produced by neuracle company was used to collect the data of the F3、F4、C3、C4、Cz、Pz、Fz sites MMN the patients,and to evaluate the CRS-R score of the patients.Statistical method :1.Analysis of variance VS/UWS group,MCS group and normal control group between the point MMN amplitude and latency of statistical differences;2.Data on the sites of patients who completed week 6 MMN,The sixth week data minus the first data absolute value,Dividing by the first data,Spearman correlation between the rate of change and the CRS-R score assessed at the sixth week of admission;3.For patients who have completed clinical monitoring and evaluation for3 months,Linear regression was used to analyze the relationship between the amplitude and latency of the first MMN and the CRS-R of the patients at admission and the third month of admission;4.Taking the CRS-R score≥ 16 as the standard for achieving the good consciousness level,the first measured MMN amplitude and the ROC curve of the patient consciousness level at week 12.If the ROC curve has statistical significance,the sensitivity,specificity,and prediction accuracy of the best bound value are calculated.Result1.VS/UWS group compared with the control group: there was no statistical difference in the latency of the point of F3、F4、C3、C4、Cz、Pz、Fz,however,F3、F4、Fz、C3、Pz amplitude difference was statistically significant(P<0.05);MCS group compared with the control group: F3、F4、C3、C4、Cz、Pz、Fz each point MMN latency and amplitude were not statistically different;VS/UWS group compared with the MCS group: F3、F4、C3、C4、Cz、Pz、Fz each point on the latency were not statistically different;F3、F4、C4、Cz、Pz、Fz amplitude difference MMN each point is statistically significant.2.There was no correlation between latency change rate and amplitude change rate of MMN points and CRS-R score at week 6.3.There was a statistically significant correlation between the amplitude of MMN at admission and the CRS-R score at the first CRS-R and week 12,There was significant correlation between MMN amplitude and CRS-R score at week 12;However,there was no correlation between latency;.4.When the first MMN amplitude reaches above 1.6 μV,the sensitivity,specificity and prediction compliance rates were 100%,57.14% and 85%.Conclution1.There is a positive correlation between the MMN amplitude and the CRS-R score,and the increased amplitude may precede the recovery of the consciousness level,while the incubation period has no predictive value;2.The lower the patient’s consciousness level,the lower the MMN amplitude;3.When the amplitude of the mismatched negative wave reaches 1.6 μV,the patient is very likely to recover to a higher level of consciousness later on. |
