脑电双频指数对急性脑梗死昏迷患者预后的评价

目的：探讨脑电双频指数（bispectral index，BIS）在急性脑梗死伴昏迷患者意识水平及预后评估中的应用价值。方法选择47例急性脑梗死伴昏迷的住院患者，评价格拉斯哥昏迷评分，并行BIS监测，记录BISmax、BISmin、BISmean数值，根据出院后3个月的改良Rankin评分（Modified Rankin Scale， mRS）分为预后良好组、预后不良组及死亡组。结果预后良好组、预后不良组及死亡组的 GCS 评分、BISmax、BISmin、BISmean差异均有显著统计学意义（P＜0.05）。BIS值与GCS评分间的Spearman等级相关性分析显示，各BIS值与GCS评分均呈显著正相关（P＜0.01）。其中BISmax、BISmin、BISmean与GCS评分的相关系数分别为r＝0.760，r＝0.793和r＝0.797。BIS值与mRS间的Spearman等级相关性分析显示，各BIS值与mRS均呈显著负相关（P＜0.01）。BISmax、BISmin及BISmean与mRS的相关系数分别为r＝-0.712，r＝-0.721和r＝-0.751。以BISmax、BISmin、BISmean值和GCS评分为检验变量，预后是否良好为状态变量（mRS≤3分为预后良好）做ROC曲线，AUC分别为0.832、0.914、0.916及0.834， P均＜0.05。BISmean ROC曲线各点对应的灵敏度和特异度结果显示，BISmean值74是预后良好的最佳截点（灵敏度为1.000，特异度为0.800）。结论 BIS 值能直接、客观的反应急性脑梗死昏迷患者的意识水平，可准确预测昏迷患者的预后，具有潜在的临床应用价值。

Bispectral index in assessing the prognosis of patients with acute cerebral infarction and in comatose states

Objective To observe the value of bispectral index（BIS） monitoring in assessing the level of conciousness and prognosis of patients with acute cerebral infarction and in comatose states. Methods 47 admitted patients with acute cerebral infarction and in comatose states were enrolled in this study. Glasgow Coma Scale（GCS） were evaluated and BIS monitored. Record the BISmax, BISmin and BISmean. the patients were divided into three groups according to Modified Rankin Scale（mRS）：good prognosis group, poor prognosis group and death group. Results The GCS, BISmax, BISmin and BISmean score of good prognosis, poor prognosis and death group were statistically significant（P＆lt;0.05）. The Spearman rank correlation analysis of BIS and GCS showed that BISmax, BISmean, BISmin were all positively correlated with GCS（P＆lt;0.01）. The correlation index followed by r=0.760, r=0.793, r=0.797. The Spearman rank correlation analysis of BIS and mRS were significantly negative correlation（P＆lt;0.01）, the correlation index followed by r=-0.712, r=-0.721, r=-0.751. With BISmax, BISmin,BISmean and GCS score for the test variables, the prognosis for the state variables （good prognosis group： mRS≤3） do ROC curves, the AUC was 0.832,0.914,0.916,0.834 respectively（P＆lt;0.05）. The sensitivity and specificity of various points in the BISmean ROC curve showed that the BISmean value 74 was the best cut point（sensitivity was 1.000, specificity was 0.800）. Conclusion The BIS Value can reflect the level of consciousness of the coma patients with acute cerebral infarction directly and objectively, predict the prognosis accurately, and had potential clinical application value.