收稿日期: 2024-07-11
网络出版日期: 2025-01-14
基金资助
河北省卫生健康委员会科研基金项目(20220675)
The value of multimodal brain function monitoring based on QEEG and TCD in evaluating hematoma enlargement and prognosis in acute hypertensive intracerebral hemorrhage
Received date: 2024-07-11
Online published: 2025-01-14
目的 评估定量脑电图（QEEG）和经颅多普勒（TCD）的多模脑功能监测在预测急性高血压性脑出血患者血肿扩大及预后的价值。 方法 回顾性分析2019年10月至2022年10月120例急性高血压性脑出血患者的临床资料。所有患者在入院24 h内接受QEEG和TCD检查，并根据血肿是否扩大将患者分为血肿扩大组（79例）和血肿稳定组（41例）。通过对比两组间QEEG和TCD的参数差异，探究这些监测指标与血肿扩大及患者预后之间的关联。 结果 血肿扩大组的患者年龄较高，且吸烟比例也较高，血肿扩大组患者的初始神经功能损伤更严重，血肿扩大组在脑出血后不同时间点的DAR和DTABR值均高于续血肿稳定组（P < 0.05）。相关性分析显示DAR、DTABR和P1与血肿扩大呈正相关，其中DAR和DTABR的相关性尤其强（r值分别为0.774和0.738，P < 0.05），P1的相关性相对较弱（r = 0.213，P < 0.05）。ROC曲线分析显示DAR、DTABR和P1参数在预测血肿扩大方面具有高灵敏度和特异度，DAR的AUC值高达0.970。随访期间，血肿稳定组的MRS评分在所有时间点上优于血肿扩大组（P < 0.05）。 结论 QEEG和TCD有助于早期识别高风险患者，从而实施更有针对性的治疗措施，改善患者的临床结果。
孙实安 , 王迎东 , 程晓峰 , 邸燕娜 , 姜健慧 , 于朝旭 . 基于定量脑电图及经颅多普勒的多模脑功能监测评估急性高血压性脑出血血肿扩大及预后的价值[J]. 实用医学杂志, 2025 , 41(1) : 114 -119 . DOI: 10.3969/j.issn.1006-5725.2025.01.019
Objective To evaluate the value of multimodal brain function monitoring using quantitative electroencephalography （QEEG） and transcranial Doppler （TCD） in predicting hematoma enlargement and prognosis in patients with acute hypertensive intracerebral hemorrhage. Methods A retrospective analysis was conducted on the clinical data of 120 patients with acute hypertensive intracerebral hemorrhage from October 2019 to October 2022. All patients underwent QEEG and TCD examinations within 24 hours of admission， and were divided into hematoma enlargement group （79 cases） and hematoma stabilization group （41 cases） based on whether the hematoma had expanded. By comparing the parameter differences of QEEG and TCD between two groups， explore the correlation between these monitoring indicators and hematoma enlargement and patient prognosis. Results The patients in the hematoma enlargement group had a higher average age and a higher smoking rate. The initial neurological damage in the hematoma enlargement group was more severe. The DAR and DTABR values of the hematoma enlargement group were significantly higher than those of the stable group at different time points after cerebral hemorrhage （P < 0.05）. Correlation analysis shows that DAR， DTABR， and P1 have significant positive correlations with hematoma enlargement， with DAR and DTABR showing particularly strong correlations （r values of 0.774 and 0.738， respectively， P < 0.05）， while P1 has relatively weak correlations （r = 0.213， P < 0.05）. ROC curve analysis shows that DAR， DTABR， and P1 parameters have high sensitivity and specificity in predicting hematoma enlargement， with an AUC value of up to 0.970 for DAR. During the follow-up period， the MRS scores of the stable hematoma group were significantly better than those of the hematoma expansion group at all time points （P < 0.05）. Conclusion QEEG and TCD are helpful in early identification of high-risk patients， enabling more targeted treatment measures and improving clinical outcomes for patients.
| 1 | CHEN F， ZHANG S， LI B， et al. A review of invasive intracranial pressure monitoring following surgery for hypertensive cerebral hemorrhage［J］. Front Neurol，2023，14：1108722. doi:10.3389/fneur.2023.1108722 |
| 2 | LIAO R， LIU L， SONG B， et al. 3D-Slicer Software-Assisted Neuroendoscopic Surgery in the Treatment of Hypertensive Cerebral Hemorrhage［J］. Comput Math Methods Med，2022，2022：7156598. doi:10.1155/2022/7156598 |
| 3 | YOSHIMOTO M， TAKEDA N， YOSHIMOTO T， et al. Hypertensive cerebral hemorrhage with undetectable plasma vascular endothelial growth factor levels in a patient receiving intravitreal injection of aflibercept for bilateral diabetic macular edema： a case report［J］. J Med Case Rep，2021，15（1）：403. doi:10.1186/s13256-021-02983-3 |
| 4 | CHEN Y， WANG L， ZHANG J， et al. Monitoring of patients with brainstem hemorrhage： A simultaneous study of quantitative electroencephalography and transcranial Doppler［J］. Clin Neurophysiol，2021，132（4）：946-952. doi:10.1016/j.clinph.2020.12.026 |
| 5 | HUANG Y， WU C， DU C， et al. A Clinical Model predicting the 90-Day Prognosis after Mechanical Thrombectomy in Patients with Acute Ischemic Stroke： A Retrospective Study［J］. Curr Neurovasc Res， 2024. doi： 10.2174/0115672026309198240605102300 . Online ahead of print. |
| 6 | 中华医学会神经病学分会脑血管病学组急性缺血性脑卒中诊治指南撰写组. 中国急性缺血性脑卒中诊治指南2010［J］. 中华神经科杂志，2010，43（2）：146-153. |
| 7 | 高山，黄家显. 经颅多谱勒超声（TCD）的诊断技术与临床应用［M］. 北京：中国协和医科大学出版社，2006：1-372． |
| 8 | 何庆璋. 葛根素与复方丹参注射液联用对急性高血压脑出血患者神经功能的改善作用［J］. 中国临床药理学与治疗学， 2012， 17（9）： 1057-1061. |
| 9 | YUAN H， FENG J， LIN X， et al. The effect of early vs. late CT-guided stereotactic hematoma aspiration on neurological function recovery in patients with hypertensive cerebral hemorrhage in the basal ganglia： A retrospective comparative cohort study［J］. Ann Palliat Med，2022，11（9）：2923-2929. doi:10.21037/apm-22-995 |
| 10 | MAO J， JIANG W， LIU G， et al. Serum calcium levels at admission is associated with the outcomes in patients with hypertensive intracerebral hemorrhage［J］. Br J Neurosurg，2019，33（2）：145-148. doi:10.1080/02688697.2019.1571162 |
| 11 | ZHAO J L， DU Z Y， SUN Y R，et al. Intensive blood pressure control reduces the risk of progressive hemorrhage in patients with acute hypertensive intracerebral hemorrhage： A retrospective observational study［J］. Clin Neurol Neurosurg，2019，180：1-6. doi:10.1016/j.clineuro.2019.02.021 |
| 12 | MAO Y， SHEN Z， ZHU H， et al. Observation on therapeutic effect of stereotactic soft channel puncture and drainage on hypertensive cerebral hemorrhage［J］. Ann Palliat Med， 2020，9（2）：339-345. doi:10.21037/apm.2020.03.12 |
| 13 | DAI Z， ZHANG L， LIU X， et al. Predictive Value of Quantitative Electroencephalogram Combined with Transcranial Doppler Ultrasound in Delayed Cerebral Ischemia after Subarachnoid Hemorrhage［J］. World Neurosurg，2024，186：e48-e53. doi:10.1016/j.wneu.2024.01.150 |
| 14 | MUELLER T M， GOLLWITZER S， Hopfeng?rtner R， et al. Alpha power decrease in quantitative EEG detects development of cerebral infarction after subarachnoid hemorrhage early［J］. Clin Neurophysiol，2021，132（6）：1283-1289. doi:10.1016/j.clinph.2021.03.005 |
| 15 | MEMON A A， CATIUL C， IRWIN Z， et al. Quantitative Sleep Electroencephalogram in Parkinson's Disease： A Case-Control Study［J］. J Parkinsons Dis，2023，13（3）：351-365. doi:10.3233/jpd-223565 |
| 16 | 蒋丽军，于倩，王伏东，等. 血压变异性联合脑血流参数在预测极低出生体重早产儿脑室内出血的作用［J］. 实用医学杂志，2023，39（16）：2116-2121. |
| 17 | FINNSDóTTIR H， SZEGEDI I， OLáH L， et al. The applications of transcranial Doppler in ischemic stroke［J］. Ideggyogy Sz，2020，73（11/12）：367-378. doi:10.18071/isz.73.0367 |
| 18 | PASTORE I， BOLLA A M， MONTEFUSCO L， et al. The Impact of Diabetes Mellitus on Cardiovascular Risk Onset in Children and Adolescents［J］. Int J Mol Sci，2020，21（14）：4928. doi:10.3390/ijms21144928 |
| 19 | HARRAR D B， SUN L R， SEGAL J B， et al. Neuromonitoring in Children with Cerebrovascular Disorders［J］. Neurocrit Care，2023，38（2）：486-503. doi:10.1007/s12028-023-01689-2 |
| 20 | 齐丽霞，李自如，姚远，等. 定量脑电图联合经颅多普勒超声对动脉瘤蛛网膜下腔出血后迟发性脑缺血的预测价值研究［J］. 实用心脑肺血管病杂志，2022，30（4）：99-103. |
| 21 | WU Y， ZHANG S， DONG Y， et al. Therapeutic Effect of Electronic Endoscopic Hematoma Removal on Hypertensive Basal Ganglia Cerebral Hemorrhage Based on Smart Medical Technology［J］. J Healthc Eng，2021，2021：7486249. doi:10.1155/2021/7486249 |
| 22 | PAVEL A M， O'TOOLE J M， PROIETTI J，et al. Machine learning for the early prediction of infants with electrographic seizures in neonatal hypoxic-ischemic encephalopathy［J］. Epilepsia，2023，64（2）：456-468. doi:10.1111/epi.17468 |
| 23 | VAN DER PLAS M C， RASING I， GERAEDTS V J， et al. Quantitative electroencephalography in cerebral amyloid angiopathy［J］. Clin Neurophysiol，2024，164：111-118. doi:10.1016/j.clinph.2024.05.013 |
| 24 | BAANG H Y， CHEN H Y， HERMAN A L， et al. The Utility of Quantitative EEG in Detecting Delayed Cerebral Ischemia After Aneurysmal Subarachnoid Hemorrhage［J］. J Clin Neurophysiol，2022，39（3）：207-215. doi:10.1097/wnp.0000000000000754 |
| 25 | CHEONG M J， SON S E， KANG H W， et al. Meditation-based clinical study to determine the correlation of quantitative electroencephalogram （qEEG） and 24-hour EEG activity［J］. Medicine （Baltimore），2018，97（43）：e12557. doi:10.1097/md.0000000000012557 |
| 26 | FENTER H， ROSSETTI A O， BEUCHAT I. Continuous versus Routine Electroencephalography in the Intensive Care Unit： A Review of Current Evidence［J］. Eur Neurol，2024，87（1）：17-25. doi:10.1159/000535085 |
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