The Research Of Clinical And Electricity Physiology Appraisal In Consciousness Disorder Patients Induced By Craniocerebral Trauma

AbjectiveTo research the value of BAEP and SEP GCS in prediction of the outcome in consciousness disorded patients.Materials and MethodsThe BAEP and SEP examination was performed on the 40 consciousness disorded patients induced by craniocerebral trauma. At the same time, Glasgow Coma scale was tested too in order to analyse the relativity between BAEP,SEP,GCS and the patients'prognosis.The male patients were 20 and the female were 20 too. The youngest was 17-year-old and the oldest was 89 years old, the mean age was 60.8±2.3 years, of which 10 cases of brain injury, temporal lobe hematoma in 6 cases,5 cases of frontal lobe hematoma, cerebellar hematoma 3 cases; epidural hematoma in 4 cases,2 cases of subdural hematoma, diffuse axonal injury in 6 cases,2 cases of hypothalamic injury, brain stem injuries in 2 cases. The selected patients were GCS scored,then were divided into two groups by GCS score level:3-8 into the severe group,8-15 into non-severe group. All the patients make bedside BAEP and SEP tests. BAEP:using TDH-39 headphones to provide the short sound stimulation, and the recording electrodes were located in the mastoid M1, M2, top center (Cz) as reference electrode, the forehead center (Epz) for the ground electrode, all the electrodes were surface electrodes and (or) needle electrodes. Skin impedance <10 Kohm, stimulus intensity of 85db while 40dB on the opposite side ear with white noise masking, the stimulate frequency was 11.1Hz, the average stack was 1000, repeat the test two or more side to show good reproducibility.The more close inspection of the waveforms overlap, indicating the less background noise, evoked potential test results were more reliable. Turn left and right ear examination by turns. SEP:electrical stimulation, using surface electrodes and (or) needle electrode, with the appropriate electrical stimulation to stimulate the median nerve at wrist, using the median nerve short latency somatosensory evoked potentials, the recording electrodes were located in the ipsilateral supraclavicular fossa boost (ie, Erb points: 2-3 cm above the intersection of sternocleidomastoid and clavicle), C7 spinous process surface and stimulate the body contralateral scalp (International 10/20 EEG electrode system) C3'/C4'point (C3 or C4 back 1 cm), the reference electrode placed Ep Point (the intersection of Central and hair), place ground electrode in stimulation forearm, wrist median nerve stimulation, impedance <10Kohm, stimulate intensity of 5-10 mA, with a slight thumb twitch can cause for the degree; frequency 4.7HZ, stack 1000, repeat test 2 to show good reproducibility. The more the two closely overlapping wave detection, indicating the less background noise, evoked potential test results more reliable. Analyze the main BAEP waves (Ⅰ,Ⅲ,Ⅴ) latency (PL),Ⅰ-Ⅲ,Ⅲ-Ⅴbetween wave latency (IPL), waveform differentiation. Analyze the median nerve SEP Erb point potential (N9), cervical spinal cord potential (N13), cortical potentials (N20, P25) of the incubation period; N13-N20 wave latency;and the waveform differentiation. Analyze BAEP, SEP waveform anomalies and GCS score and the relationships among them.ResultsSEP monitoring results:8 normal,32 showed abnormal; the abnormal form of potential abnormality, in which the lack of N20 wave, PL prolonged and amplitude decreased, the waveform poor, poorly differentiated the most common. SEP abnormalities in 32 cases of patients with good prognosis of patients the number of cases and 8 cases, the number of patients with poor prognosis for the 24 cases. When the SEP in abnormal SEP poor prognosis was significantly higher than normal rate of poor prognosis (significantly); and if accompanied by abnormal BAEP, then the higher rate of poor prognosis; (2) BAEP monitoring results:16 cases normal,24 cases of abnormal I common abnormality in the form of the wave after wave latency (PL) extension of IPL (IPL) to extend, and poorly differentiated waveform. BAEP waves which monitoringⅢ,Ⅴwaves are present in patients with good prognosis, patients often isolated and the lowest total disappearance of the state of consciousness (MCS), persistent vegetative state or death.24 patients with abnormal BAEP monitoring results in patients with poor prognosis in 20 cases, poor prognosis was significantly higher than the normal BAEP. (3) in 14 patients the BAEP examination ofⅢ-Ⅴwave and SEP disappeared while checking the N20 wave, all of these patients with poor prognosis. (4) GCS score:non-severe group of 6 patients, of whom a good prognosis,4,2 poor prognosis; severe group were 34 people, including poor prognosis and 24 good prognosis 10. BAEP examination ofⅢ-Ⅴwave and SEP N20 wave also check the disappearance of severe patients, all of a poor prognosis.ConclusionN20 of the PL and N13-N20 of IPL, is useful in determining the prognosis of coma patients indicators; BAEP and SSEP combined check the accuracy of prognosis, higher than a single test; BAEP major obstacle auditory pathway, while the SEP reflects the hypothalamus and cerebral hemisphere cortex lesion; brain stem auditory evoked potentials and somatosensory evoked potential testing can be combined to more accurately determine the prognosis of consciousness; GCS score vulnerable to early onset of drug, tracheal intubation, tracheotomy, physical trauma interference, and many other factors affect their prognosis; whole, evoked potentials in the prognosis broadly consistent with the evoked potential, scoring high and low and evoked potential abnormalities on whether or not there were statistically significant correlation.