The Value Of Brain Function Monitoring In Coma Patients

Background and ObjectiveComa is a common nonspecific clinical symptom in intensive care unit(ICU).According to the clinical manifestations of patients,coma is divided into mild coma,moderate coma and deep coma.Coma patients are usually sicker and require prompt treatment.In addition to medical history collection and neurophysical examination,coma patients often need imaging examination and laboratory examination to further obtain the brain status of patients.Common imaging examinations include computed tomography(CT),magnetic resonance imaging(MRI)and so on.According to them,the location,scope and degree of brain injury can be understood,and the disease development and outcome can be observed dynamically.Due to limited conditions,the above examinations often require patients to go out,which always bring risks.Laboratory examination,such as cerebrospinal fluid biochemistry and etc,often require a longer wait time.The tools commonly used to evaluate the consciousness level of coma patients include Glasgow scale(GCS)and so on,which are simple to operate but lack of objectivity.The monitoring of brain function can be carried beside the bed,which can obtain the information of patients in a shortest time.Electroencephalogram(EEG)is the sum of the electrical activities of cerebral cortical nerve cells,which can reflect the functional state of the brain.The accuracy and practicability of this method for patient monitoring are still controversial due to its easy interference by the environment,electronic devices and other factors.Clinical EEG is complex and usually requires professional interpretation.With the development of modern medicine and science and technology,information technology is integrated with EEG,and quantitative EEG(qEEG)is produced.While retaining some features of the original EEG,qEEG makes EEG objective,concise and intuitive.qEEG commonly used to represent the functional state of brain include amplitude trend electroencephalogram(aEEG),band power,spectral entropy,α variability,envelope analysis,etc.All the above indicators are integrated from EEG,but they are different to EEG.At present,the monitoring of brain function is mainly used for the the monitoring of therapeutic effect and epilepsy,the assessment of prognosis.In this study,the values,symmetry and correlation of the above monitoring indexes were analyzed in order to further evaluate the application value of brain function monitoring in coma patients.Method1.Comatose patients admitted to the critical care unit of the First Affiliated Hospital of Zhengzhou University from May 2018 to March 2019 who accepted brain function monitoring were selected.The total number is 46.Patients were groupedaccording to the etiology of coma.Their basic information,clinical data,brain function monitoring indicators and Glasgow scale(GCS)and acute physiology and chronic health scale Ⅱ(APACHEⅡ)scores were recorded.GCS score and APACHEⅡ score were performed at the day of monitoring.Indicators of brain function monitoring included aEEG,brand power,α variability,spectral entropy and envelope analysis.2.Measurement data were expressed as mean standard and deviation.Rank sum test was used for comparison of ordered classification data.χ2 test or Fisher exact probability test were used for counting data.Spearman correlation was used to analyze the relationship between aEEG,APACHEⅡ,GCS and spectral entropy.Results1.A total of 46 coma patients were monitored for brain function,including 31 males and 15 females.The mean age was(45.35±17.06)years old.Coma duration at admission was(9.23±2.07)days.The mean GCS score was(4.43±1.72).The mean APACHE Ⅱ score was(18.98±4.90).2.Grade of aEEG:Grade Ⅰ(normal amplitude),30 cases,Grade Ⅱ(mildly abnormal amplitude),7 cases,Grade Ⅲ(heavy abnormal amplitude)9 cases.There was no statistical significance in gender,APACHEⅡ score and GCS of patients in the traumatic head injury group and the brain stem and basal ganglia hemorrhage group(P>0.05),but there was a difference in age which had statistical significance(P<0.05).The aEEG grading between the groups were difference and had statistically significant(P<0.05).There were no no differences in age,gender,APACHEII score and GCS score between the traumatic head injury group and the ischemic and hypoxic encephalopathy group(P>0.05),and the aEEG grading between the two groups was different and had statistically significant(P<0.05).3.There were 29 patients with symmetric aEEG,and 19 patients were asymmetric.There were 19 patients with symmetric spectral entropy,and 27 patients were asymmetric.There were 5 patients with symmetric α variability,and 41 patients were asymmetric.There was no statistical significance in the symmetry of aEEG and RBP between traumatic head injury and patients with cerebral stem or basal ganglia hemorrhage,also no statistical significance between traumatic head injury and ischemic and hypoxic encephalopathy patients.About spectrum entropy,there were 10 patients with between 0～25,30 cases between 26～50,6 cases between 51～75,and 0 cases between 76-100.4.Spearman correlation analysis showed that GCS was negative correlated with APACHEⅡ score,while aEEG was not correlated with APACHEⅡ score and GCS score,GCS score was not correlated with spectral entropy.Conclusion1.The extent and depth of brain injury in coma patients can be determined by brain function monitoring.2.aEEG cannot accurately reflect the severity of brain injury in coma patients at different stages.3.The accuracy of spectral entropy in determining coma depth of coma patients needs further study.