| The management of NICU after craniocerebral trauma is very important in the whole treatment process.Preventing secondary damage,treating severe complications and improving the prognosis of coma patients are all difficult problems to be solved in the field of severe neurological diseases.With the new concept of multi-modal monitoring in recent decades,amplitude integrated electroencephalogram(AIEEG)has been applied to NICU,and the application scope of clinical treatment program for traumatic brain injury patients based on EEG parameters has gradually expanded.At the same time,because the clinical significance and underlying mechanism of EEG parameters in patients with craniocerebral trauma need to be further studied,we monitored and analyzed EEG parameters in patients requiring sedation after operation,patients with long-term coma who were awakened by electrical stimulation therapy,and used EEG fast-slow wave ratio to evaluate whether different types of early epilepsy patients need early regulation.Fan anti-epilepsy treatment,so as to explore the brain wave,EEG background model and fast-slow wave ratio of patients with brain trauma to predict the condition,guide the treatment of important guiding value..To explore the application value of EEG power value in the evaluation of sedation depth,we included the clinical data of 42 patients with craniocerebral trauma after operation.Sedation with Dexmedetomidine(Dex)was given after the operation.The basic vital signs such as body temperature,respiratory rate and oxygen saturation were recorded at each time point before and after the use of drugs,10 minutes,30 minutes,60 minutes and 90 minutes,and Ricker sedation-restlessness(SAS)score was performed.During the procedure,the changes of EEG power values at four frequencies of α、β、θ and δ were continuously recorded and compared with corresponding SAS for relevance analysis.It was found that the EEG power values in δ band of each brain region were negatively correlated with SAS,which could objectively and effectively reflect the dynamic changes of sedation depth.The correlation coefficients between absolute values of δ band power in bilateral frontal regions(F3、F4)and SAS were all 0.88(P < 0.01),which were the two parameters with the highest correlation coefficients compared with all other brain regions,and had better guiding significance for clinical sedation.Coma awakening is an urgent task in the field of neurosurgery.In order to further explore which TBI coma patients can be treated with median nerve electrical stimulation and improve their prognosis effectively,51 coma patients who have not recovered consciousness for 2 weeks after craniocerebral trauma operation in intensive care unit(ICU)were enrolled.GCS and a EEG of patients were assessed while median nerve electrical stimulation(RMNS)was performed.With analysis of EEG background pattern、EEG activity and the brain function grade score(CPC)obtained after 6 months follow-up,we found that patients with A pattern(CNV)of EEG background had good prognosis of neurological function.The sensitivity and specificity of this pattern were 91.3% and 85.7% respectively.Patients in pattern C(CLV,BS,FT)had poor 6-month neurological prognosis,with sensitivity and specificity reaching 78.6% and 100% respectively.Pattern B(DNV)has a lower accuracy in predicting the prognosis of both patients with good prognosis and patients with poor prognosis.GCS had lower sensitivity and specificity in predicting good prognosis and poor prognosis,and the area under curve of a EEG was 0.933(95% CI:0.835-0.961),which was also better than 0.701(95% CI: 0.615-0.776)of GCS(P <0.01).It is concluded that a EEG background model is a better tool for predicting the benefit of RMNS treatment for TBI comatose patients,and its predictive ability is stronger than that of GCS.Early detection,diagnosis and treatment of traumatic epilepsy are particularly important for improving long-term EEG activity and reducing impairment of cognitive and memory function.A total of 64 patients with PTE early epilepsy were divided into abnormal discharge test group,abnormal discharge control group and clinical seizure with abnormal EEG discharge group according to the type of seizures.By comparing the relative power ratio of slow-wave to fast-wave in 10 brain regions and the score of cognitive memory function scale between the three groups after 3 months,it was found that patients with early epilepsy who only had abnormal EEG discharges could benefit from long-term standard AEDs administration.It was also found that S values in bilateral temporal lobes and right frontal lobes were correlated with cognitive and memory function in patients with early PTE epilepsy,but there were some limitations in using S values to evaluate cognitive and memory function in such patients.This series of studies provides a new idea for the choice of NICU treatment for patients with craniocerebral trauma by digging quantitative EEG spectrum analysis function,integrating EEG background mode with amplitude and relative power ratio of slow wave and fast wave. |
PDF Full Text Request