Evaluation Of Prognosis Of Severe Cerebrovascular Disease By Brain Function Monitoring Combined With Inflammatory Factors

Objective To explore the significance of neurophysiological monitoring in brain function monitoring methods combined with the values of serum inflammatory factor for the prognostic evaluation of patients with severe cerebrovascular disease,and to find a relatively accurate,perfect and objective method to predict the prognosis of patients with severe cerebrovascular disease,and then provide better guidance for clinical diagnosis and treatment.Methods Sixty patients with severe cerebrovascular disease(SCVD)admitted to our neurology intensive care unit(NICU)from December 2018 to January 2020 were selected.Glasgow Coma Scale(GCS),electroencephalography(EEG),short-latency somatosensory evoked potential(SLSEP),brainstem auditory evoked potential(BAEP)and transcranial Doppler(TCD)monitoring were performed in eligible patients with severe cerebrovascular disease within 24 hours after admission.Peripheral venous blood samples were drawn on the morning of 1d,3d,7d and 14d after admission and submitted to the clinical laboratory of our hospital for detection of serum interleukin-6(IL-6)and hypersensitive C-reactive protein(hs-CRP).Death within 30 days or 30 days after onset was used as the observation endpoint,and at the observation endpoint,they were divided into good prognosis group(grade IV,V)and poor prognosis group(grade I,II,III)according to Glasgow Outcome Scale(GOS).Finally,the relationship between neurophysiological monitoring and the values of serum inflammatory factor and the prognosis of severe cerebrovascular disease was analyzed,and the prediction method of the combination of the six indicators was compared with each single monitoring in terms of prediction sensitivity,specificity,Youden index and accuracy,and the prognostic predictive value of severe cerebrovascular disease by ROC analysis was compared with Glasgow Coma Scale.Results(1)Binary logistic regression analysis was performed with gender,age,disease type,EEG,BAEP,SLSEP,TCD,IL-6 and hs-CRP as independent variables and GOS as dependent variable,and the results revealed that the monitoring results of EEG(P=0.007),SLSEP(P=0.038),BAEP(P=0.011),TCD(P=0.045),IL-6(P=0.007),and hs-CRP(P=0.033)all had a significant effect on the prognosis of patients with SCVD,indicating that these six indicators can be used to predict the prognosis of patients with SCVD.(2)To compare the sensitivity,specificity and accuracy of six indexes combined with each single index in predicting the prognosis of severe cerebrovascular disease,χ~2analysis revealed significant differences between the combination of the six indicators and each single index in terms of predictive sensitivity(χ~2=34.125,P<0.001)and accuracy(χ~2=26.1,P<0.001),and the combination of the six indicators was superior to each single item in terms of predictive sensitivity and accuracy for prognosis,and the Youden index was the largest.There was no significant difference between the combination of the six indicators and each single index in terms of prediction specificity(χ~2=9.632,P=0.21),and the combination of the six indicators failed to improve the specificity of prediction.(3)The predictive value of the combination of the six indicators and GCS score for prognosis was compared by ROC analysis,and the results showed that the predictive efficacy of the combination of the six indicators(AUC of0.953,95%CI of 0.892 to 1.000)for prognosis was significantly better than that of GCS score(AUC of 0.754,95%CI of 0.596 to 0.912),and the AUC of the two was compared with the Z test(Z=2.294),and the difference was statistically significant(P=0.022).Conclusion(1)After the occurrence of SCVD,the results of EEG,SLSEP,BAEP and TCD monitoring can be used to predict the prognosis of brain function in patients.(2)The level of serum inflammatory factors(IL-6,hs-CRP)on the third day can be used to predict the prognosis of patients with severe cerebrovascular disease.(3)The monitoring methods of EEG,BAEP,SLSEP,and TCD combined with serum inflammatory factors(combination of six indicators)can more accurately predict the prognosis of patients with SCVD.The combination of six indicators significantly improves the prediction sensitivity and accuracy compared with each item alone for the prediction of prognosis,and has a excellent predictive value for the prognosis compared with the traditional Glasgow Coma Scale.(4)The combination of the six indicators is of great significance for the estimation of symptoms,the evaluation of prognosis and treatment of patients with SCVD.The combination of the six indicators for the prognosis evaluation of patients with SCVD can relatively accurately evaluate the prognosis of patients,and has the value of being worthy of clinical application and implementation.