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急性脑损伤后无反应患者的脑激活情况检测
Detection of Brain Activation in Unresponsive Patients with Acute Brain Injury


Jan Claassen ... 其他 • 2019.06.27

NEJM发表首篇人工智能临床研究:精准判断脑损伤患者意识水平

 

张晔,宋为群*

首都医科大学宣武医院康复医学科

*通讯作者

 

在脑损伤后早期精准判断患者的意识水平及预后情况,不仅直接影响临床治疗策略的选择,甚至还会影响亲属对患者生死去留的抉择。

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摘要


背景

对于临床上无反应的患者,脑电图(EEG)可检测出患者对语音运动指令做出反应时的脑激活。目前尚未充分了解脑损伤发生后数日内,指令下的运动行为与脑激活相分离的发生率和预后意义。

 

方法

我们在一个重症监护病房内对前瞻性、连续病例系列进行了研究,这些患者发生了各种原因导致的急性脑损伤,并且对语音指令无反应,其中包括一些有能力定位疼痛刺激或者固视或追踪视觉刺激的患者。机器学习被应用到EEG记录中,用于检测研究者发出“动一下手”的指令后,患者对这一指令做出反应时的脑激活。采用扩展版格拉斯哥结局量表(Glasgow Outcome Scale-Extended,GOS-E;分级范围为1~8级,分级较高表示结局较好)确定12个月时的功能结局。

 

结果

损伤后4日(中位数),EEG在104例无反应患者中检测出16例(15%)有脑激活。这16例患者中的8例以及88例无脑激活患者中的23例(26%)病情改善,他们在出院之前具备了遵循指令的能力。12个月时,16例脑激活患者中的7例(44%)和84例无脑激活患者中的12例(14%)的GOS-E分级≥4级,表明日间患者能够自理长达8小时(比值比,4.6;95%置信区间[CI],1.2~17.1)。

 

结论

在发生急性脑损伤的连续病例系列中,我们发现15%的患者存在行为反应与脑激活相分离的情况,即患者未对运动指令做出行为反应,但EEG记录证明患者对这些指令做出反应时有脑激活(由达纳基金会[Dana Foundation]和詹姆斯麦克唐奈基金会[James S. McDonnell Foundation]提供支持)。





作者信息

Jan Claassen, M.D., Kevin Doyle, M.A., Adu Matory, B.A., Caroline Couch, B.A., Kelly M. Burger, B.A., R.E.E.G.T., Angela Velazquez, M.D., Joshua U. Okonkwo, M.D., Jean-Rémi King, Ph.D., Soojin Park, M.D., Sachin Agarwal, M.D., David Roh, M.D., Murad Megjhani, Ph.D., Andrey Eliseyev, Ph.D., E. Sander Connolly, M.D., and Benjamin Rohaut, M.D
From the Departments of Neurology (J.C., K.D., A.M., C.C., K.M.B., A.V., J.U.O., S.P., S.A., D.R., M.M., A.E., B.R.) and Neurosurgery (E.S.C.), Columbia University, and the Department of Psychology, New York University (J.-R.K.) — both in New York. Address reprint requests to Dr. Claassen at the Neurological Institute, Columbia University, 177 Fort Washington Ave., MHB 8 Center, Rm. 300, New York, NY 10032, or at jc1439@columbia.edu.

 

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