| Objective:To explore the early evaluation of amplitude integrated electroencephalography(aEEG)on the prognosis of acute brain injury in critically ill children in plateau area,so as to seek a more suitable brain function monitoring method for PICU in plateau area.Methods:in the Tibet autonomous region people’s hospital Pediatric intensive Care Unit(PICU)from June 2019 to October 2020 make a diagnosis and give treatment of 83 cases of acute brain injury patients as the target object of the present study for the condition:consider for when hospitalized children with acute brain injury,improve the Glasgow coma scale<14 points amplitude integration of aEEG monitoring time limit is2-4 hours;Age at admission>1 month;No sedatives were used in the 24hours prior to monitoring.Exclusion criteria:age≥28days;The interference artifact is obvious.Disorder of electrode placement(post-surgical,severe traumatic brain injury);The child is automatically discharged from hospital due to various reasons or dies within 24 hours after admission;Sedative and antishock drugs were used before amplitude integrated aEEG monitoring,aEEG was recorded within hours and the duration of each monitoring was 2-4 hours.The modified Glasgow coma score was performed before amplitude integrated aEEG monitoring was initiated or within 24 hours after admission.aEEG results are graded according to the amplitude of integration,the amplitude can be integrated electroencephalography presented the results is roughly divided into two levels:level I through to the data processing and analysis of amplitude aEEG evaluation boundaries and incorporated into a demarcation line is more than 10 uv on integration of electroencephalogram,the demarcation line is greater than 5uv integrate the aEEG amplitude said normal aEEG:class II through the data processing and analysis of amplitude aEEG evaluation boundaries and incorporated into a demarcation line is more than 10 uv on integration of electroencephalogram,defining the line less than or equal to 5uv under north electroencephalography.Picture said mildly abnormal aEEG amplitude integration,or on the demarcation line less than or equal to 10uv,demarcation line is greater than 5uv under the aEEG amplitude also said mildly abnormal aEEG amplitude integration:III level through the data processing and analysis of amplitude aEEG evaluation boundaries and incorporated into a integrated aEEG demarcation line on less than 10uv,demarcation line is less than 5uv under the aEEG amplitude said severely abnormal aEEG amplitude integration.According to the modified Glasgow coma score,there were three types.The scores and their corresponding values were accumulated.The accumulated values ranged from 3 to 8 as severe;from 9 to 11 as moderate;In 12 to 14 were divided into mild,the prognosis of follow-up way is divided into two kinds of telephone follow-up or a follow-up to the college,rule 3 months after discharge for the prognosis of follow-up period,in case of death in the follow-up period of termination of the follow-up,After PCPC grading,those rated IV-VI were considered to have a poor prognosis.If the clinical death occurs within 3 months after discharge,the prognosis is also poor.The prognosis was classified into good group on the scale of I-III.The relationship between aEEG grade and prognosis,the relationship between aEEG grade and improved GCS,and the relationship between improved GCS and prognosis were compared.X~2test was used to statistically analyze the differences between the prognosis results.Spearman analysis was used to explore the early evaluation of aEEG on the prognosis of critically ill children with acute brain injury in the plateau area.Results:83 cases of acute brain injury for children,children with acute brain injury aEEG normal 36 cases,show the continuity of the normal voltage 30 patients(83.3%),characterized by continuous low voltage in 2 cases(5.6%),4 cases of epilepsy is shown as sample discharge(11.1%),of which 32 cases with good prognosis,and poor prognosis in 4 cases,aEEG was abnormal in 47(abnormal rate 56.6%),17 cases with mild exceptions(fester sex meningitis in 5 cases,1 cases of autoimmune encephalitis,cerebral hemorrhage in 2 cases,2 cases of diabetic ketoacidosis,bacterial dysentery in 1 case,1 cases of severe pneumonia,septic shock 3 cases,2 cases of viral meningitis)show the continuity of the normal voltage in 2 cases(11.8%),characterized by continuous 4 cases(23.5%),characterized by low voltage explosion suppression in 5 patients(29.4%),characterized by pain sample discharge6 cases(35.3%),8 cases with good prognosis,9 cases of poor prognosis and 4 severely abnormal 30 cases(10 cases of purulent meningitis and cerebral hemorrhage in 7 cases,9 cases of septic shock,4 cases of acute leukemia)is characterized by continuous low voltage outbreak of 7 cases(23.3%),characterized by inhibition of 6 cases(20%),18 cases(60%)of disease sample discharge 0 cases had good prognosis and 30 cases had poor prognosis.According to the modified GCS score,the children with acute brain injury in the critical children in the plateau area were divided into 29 cases(34.9%)for mild,24 cases(28.9%)for moderate,and 30cases(36.2%)for severe.There was no difference in gender and age between the good prognosis group and the bad group,and there was no significant difference in gender and age between the good prognosis group and the bad group after statistical Chi-square test(X~2=0.006P=0.941;X~2=0.289 P=0.962);aEEG as a non-invasive bedside monitoring method,was in good agreement with the modified Glasgow coma score,and the difference between aEEG and the modified Glasgow coma score was statistically significant after statistical chi-square test(X~2=91.206P=0.000).When amplitude integration aEEG abnormal background activities increased significantly,and by PCPC judge the prognosis of defective rate value is increased in varying degrees,after statistics of card party inspection conclusion aEEG and prognosis have significant difference between the statistical significance(X~2=51.796 P=0.000),and through the analysis of the spearman aEEG grading and prognosis related numerical,r=0.789,P=0.000,Spearman analysis showed the correlation between AEEG grade and prognosis,r=0.789.P=0.000,namely the aEEG was positively related to relationship between classification and prognosis of defective rate,integrating the amplitude of aEEG monitoring in 83 cases,among them 4 severely abnormal aEEG background activity has 30 cases,not for a good prognosis,30 cases of poor prognosis,and the prognosis of defective rate is significantly higher than normal background aEEG and mildly abnormal background aEEG,aEEG amplitude integration for children with abnormal discharge of its poor prognosis proportion(81%),nervous system development Prognosis compared with no abnormal discharge amplitude integration of electroencephalogram there was no statistically significant difference(P>0.05),when acute brain injury,improve the Glasgow coma scale score will be increased with the severity of acute brain injury and reduce its by PCPC judging the prognosis of defective rate rise,then after a series to learn chi-square difference was statistically difference(X~2=35.586P=0.00)Conclusion:aEEG as a kind of bed invasive monitoring means,consistent with improved Glasgow faint sent scale,good for period evaluation of children with acute brain injury in plateau area has important clinical significance,when the amplitude of the higher integration of electroencephalogram background of abnormal brain electrical activity,and the higher the defective rate numerical prognosis,aEEG grading and prognosis between the difference was statistically significant.aEEG can be used for early evaluation of prognosis. |
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