Prognosis Factors Research In Adult Patients With Hypoxic-Ischemic Encephalopathy

The disease of HIE is the most serious complication when recoveringfrom cardiopulmonary resuscitation, is vital harm for patients, willbring with heavy burden for society. Although brain resuscitation takesover important status in guideline of CPR, there is no better way to finishbrain resuscitation effectively. Recently mild hypothermia therapy hasbeen very effective measure to be applied with HIE especially for moderateor severe HIE, however, mild hypothermia therapy must be implementedwithin window of time (within six hours). So looking for sensitive indexis necessary for clinical doctors to help with diagnosing moderate orsevere HIE early. Transcrnial and electroenphogram is a recentlydeveloped technique, which is suitable for the monitoring of neonatalcerebral function. It could predict the severity and neurological outcomeof HIE. There is no related study for adult patients with HIE availablein China up to now.The impaired cerebral autoregulation and hemodynamics are the primarypathophysiologic mechanisms of brain injury in HIE. It is difficult forjudging and assessing state and prognosis of patients who suffer CPR andit is not very exact only according to time of cardiac arrest and lastingtime of coma. In other hand, The examination of CT、MRI usually been limitedbecause it is not convenient and moved for patients when they are in intensive care unit. TCD、AEEG has many advantages for monitoring cerebralfunction in adult patients with HIE, which is they are sensitive, easilyoperate, its mobility, its repeatability and its sustainability. Thereare few studies about the combined application of these techniques andanalyze high risk factors in adult HIE.The study is designed:1. to analyze clinical features different from control group,look for high risk factors of HIE2. to investigate techniques of TCD and AEEG were applied in HIE,to assessthe effect of TCD and AEEG on early diagnosis brain injury andprediction of long outcome in adult HIE. The objective is to seek mostvaluable method for cerebral function and judging prognosis in adultpatients with HIE.Part One Clinical Features Analyzing And Seeking Influencing FactorsFor Adult Patients With HIE[Objective] To study clinical features in adult patients with HIE, andseek high risk factors, it would provide some evidences for treat withHIE early.[Method] Sixty patients without happening HIE and sixty patients with HIEwere collected from intensive care unit of the second hospital affiliatedGuangzhou medical college. All clinical data were assembled and wereanalyzed between May in2010and October in2011. We also analyzed thecorrelation between high risk factors and prognosis of patients with HIE.Finally, we analyzed how clinical index and examination resultsinfluenced prognosis of patients with HIE by logistic method.[Results]1. The ratio of the history of hypertension、stroke、diabetesand coronary disease is higher in HIE group than control group, which hassignificant difference between them (P<0.05). 2.The result indicate from logistic analyzing that indexes of white cellcount、Hb、ALB、CREA、PO2and LAC are influencing factors for HIE happening.Part Two Cerebral Function Monitoring In Adult Patients With HIE[Objective] To assess value of brain injury and its prognosis by combinedapplication of TCD、dynamic EEG in adult patients with HIE.[Method] Sixty patients with HIE were monitored by TCD and dynamic EEG，all patients were scored by Glasgow standard and then keep following withoutcome of all patients. The results of Glasgow score、TCD and dynamicEEG were compared about sensitivity and specificity between the twogroups.[Results]1. The results from TCD monitoring showed that adult patientswith HIE were in a state of low resistance and high perfusion early afterHIE, the value of Vs、Vm、and Vd was increased and value of PI and RI wasdecreased.2. The cerebral blood velocity about Vs、Vm、Vd and PI、RI has relevancewith extent of brain injury, the results indicated that the higher aboutvalue of cerebral blood velocity and lower about value of PI、RI, the moreimpossible about severe brain injury in adult patients with HIE.3. The classification level from dynamic EEG results showed that most ofpatients with HIE could get rehabilitation completely if level I and levelII in dynamic EEG monitoring. The clinical prognosis was poor in levelIII of EEG monitoring. Only one patient could get rehabilitation and twopatients leaved over neurological function disorder, seven patients werein a state of vegetable, and two patients had died. The prognosis was thepoorest about level IV and V of dynamic EEG monitoring. Nine patients werein a state of vegetable and seven had died. We could find from exact datait was closely related between level of EEG and clinical outcome. 4. The area under the cure about Glasgow score was0.868, the sensitivitywas percent of76.7, specificity was percent of80.0, exactness ratio waspercent of78.3, and fault ratio was percent of10.0; the area under thecure about Glasgow scoring combined dynamic EEG monitoring was0.980, thesensitivity was percent of93.1, specificity was percent of90.3,exactness ratio was percent of90.6, and fault ratio was percent of5.0by using ROC cure analyzing.5. The test result of ⅹ2method indicated that the sensitivity、specificity and exactness ratio about Glasgow scoring combined dynamicEEG monitoring were higher than used by Glasgow scoring, however, thefault ratio was lower, which was significant difference between them forjudging clinical outcome(P<0.05).[Conclusions]1. The history of heart and cerebral diseases and diabetics is promotingfactors in patients with HIE.2. The white cell count、CREA、LAC and so on are important indexes forinfluencing prognosis of patients with HIE.3. TCD is valuable for monitoring severity of illness and clinicalprognosis for patients with HIE, however, Vm and RI are better indexesduring monitoring.4. The monitoring method of Glasgow scoring combining with active EEG ismore clinical practice meaningful for applying with estimate severity ofillness and clinical prognosis than the method of single Glasgow scoringor dynamic EEG.