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

doi:10.3969/j.issn.1006-5725.2025.01.019

Abstract

Abstract:

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.

Key words: acute hypertensive intracerebral hemorrhage, hematoma enlargement, quantitative electroencephalogram, transcranial Doppler, prognosis

CLC Number:

R816.1

Shi′an SUN,Yingdong WANG,Xiaofeng CHENG,Yanna DI,Jianhui JIANG,Chaoxu YU. The value of multimodal brain function monitoring based on QEEG and TCD in evaluating hematoma enlargement and prognosis in acute hypertensive intracerebral hemorrhage[J]. The Journal of Practical Medicine, 2025, 41(1): 114-119.

Figures/Tables 7

Tab.1

Tab.2

Tab.3

Tab.4

Tab.5

Fig.1

Tab.6

References 26

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 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 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 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 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. doi: 10.2174/0115672026309198240605102300
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 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 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 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 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 doi: 10.1016/j.wneu.2024.01.150
14	MUELLER T M， GOLLWITZER S， Hopfengärtner 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 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 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 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 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 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 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 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 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 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 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 doi: 10.1159/000535085

项目	血肿稳定组（n = 41）	血肿扩大组（n = 79）	χ ² /t/Z值	P值
年龄/岁	61.44 ± 12.36	66.98 ± 12.74	2.282	0.024
饮酒/例	13	36	2.146	0.142
吸烟/例	16	48	5.123	0.023
高血压史/例	20	53	3.797	0.051
高脂血症史/例	14	32	0.461	0.496
糖尿病史/例	9	18	0.010	0.917
收缩压> 160 mmHg/例	6	49	24.418	0.000
凝血酶原时间/s	13.45 ± 0.93	13.32 ± 0.87	0.758	0.449
活化部分凝血活酶时间/s	38.53 ± 8.56	38.11 ± 7.93	0.267	0.789
入院格拉斯哥昏迷评分［M（P₂₅，P₇₅）］/分	15.00（15.00，15.00）	11.00（7.00，15.00）	6.995	0.000
入院国立卫生研究院卒中量表评分［M（P₂₅，P₇₅）］/分	1.00（0.00，3.00）	14.00（4.50，24.00）	7.292	0.000

项目	时间点	血肿稳定组（n = 41）	血肿扩大组（n = 79）	t值
DAR	脑出血发病后第一次检测	0.09 ± 0.01	0.19 ± 0.05	12.651
	发病6 h	0.13 ± 0.04	0.22 ± 0.05	9.980
	发病24 h	0.07 ± 0.03	0.17 ± 0.01	29.966
	发病72 h	0.02 ± 0.01	0.10 ± 0.02	24.064
DTABR	脑出血发病后第一次检测	0.68 ± 0.16	1.04 ± 0.13	13.275
	发病6 h	0.85 ± 0.20	1.27 ± 0.23	9.905
	发病24 h	0.62 ± 0.20	0.81 ± 0.14	6.062
	发病72 h	0.24 ± 0.05	0.42 ± 0.10	10.829

项目	血肿稳定组（n = 41）	血肿扩大组（n = 79）	t值	P值
Vs/（cm/s）	81.20 ± 20.44	79.24 ± 18.26	0.535	0.593
Vd/（cm/s）	22.80 ± 12.48	19.70 ± 11.10	1.390	0.167
Vm/（cm/s）	39.73 ± 14.25	35.27 ± 14.58	1.601	0.112
P1	1.60 ± 0.63	1.94 ± 0.82	2.321	0.021

评价指标	DAR		DTABR		P1
评价指标	r值	P值	r值	P值	r值	P值
血肿扩大	0.774	0.000	0.738	0.000	0.213	0.019

指标	AUC	敏感度/%	特异度/%	约登指数	95%CI	截断值
DAR	0.970	92.4	100.0	0.924	0.938 ~ 1.000	0.12
DTABR	0.949	93.7	87.8	0.815	0.907 ~ 0.992	0.85
P1	0.630	36.7	90.2	0.269	0.530 ~ 0.729	2.24
三者联合	0.993	93.7	100.0	0.937	0.983 ~ 1.000	-

The value of multimodal brain function monitoring based on QEEG and TCD in evaluating hematoma enlargement and prognosis in acute hypertensive intracerebral hemorrhage

RichHTML

PDF (PC)

Knowledge

Abstract

Cite this article

share this article

Figures/Tables 7

References 26

Related Articles 15

Recommended Articles

Metrics

Comments

时间点	血肿稳定组（n=41）	血肿扩大组（n=79）	t值
发病前	2.34±0.23	2.72±0.33	6.584
出院时	1.73±0.20	1.93±0.26	4.305
出院后1个月	1.69±0.13	2.34±0.32	12.463
出院后3个月	1.75±0.16	2.41±0.28	13.940
出院后6个月	1.77±0.20	2.44±0.34	11.605

[1]	Xiaomei CHEN,Anqi WANG,Jizhen YANG,Miao YU. Prognosis and immune correlation analysis of m1A/m5C/m6A/m7G regulated genes in gastric cancer [J]. The Journal of Practical Medicine, 2024, 40(9): 1230-1237.
[2]	Shihe XIAO,Gang LI,Zhonghai LIU,Zhen. LIU. Expression of ZEB2 and CCL20 in glioma tissue and their correlation with prognosis [J]. The Journal of Practical Medicine, 2024, 40(9): 1262-1267.
[3]	Futao DANG,Yingmei TANG,Haiyan FU,Huanlong LI,Jiamin XU,Xu. TAN. The efficacy of artificial （nonbiological） extracorporeal liver support system for primary biliary cholangitis and the effect of this therapy on prognosis [J]. The Journal of Practical Medicine, 2024, 40(7): 955-961.
[4]	Xiya MA,Hu JI,Zehua ZHU,Bo PAN,Qiang XIE,Xiaobo. YAO. The predictive value of ¹⁸F⁃FDG PET/CT metabolic heterogeneity parameters combined with clinical features for the prognosis of esophageal squamous cell carcinoma before definitive radiochemotherapy [J]. The Journal of Practical Medicine, 2024, 40(7): 966-971.
[5]	Yuxin CHENG,Liang LIU,Shiyu DONG,Shengchao LI,Meng ZHANG. Research advances in exosomal proteins， mRNA and non⁃coding RNA regulation of Hepatocellular Carcinoma [J]. The Journal of Practical Medicine, 2024, 40(6): 748-755.
[6]	Sibo LONG,Yan CHEN,Xintong ZHANG,Yanjun YIN,Limei YANG,Maike ZHENG,Chaohong WANG,Qing SUN,Jun YAN,Yiheng SHI,Guangli SHI,Yan ZHAO,Guirong. WANG. Serum levels of procalcitonin， interleukin⁃6 and interleukin⁃8 in patients with COVID⁃19 infection at admission and their significance in patient prognosis [J]. The Journal of Practical Medicine, 2024, 40(4): 471-475.
[7]	Zixu SONG,Guangzheng ZHU,Chenxu GUO,Jiaqi WU,Ligong ZHANG,Jun. QIAN. Expression of SLC35A2 and PFDN2 in breast cancer and its relationship with clinical observables and prognosis [J]. The Journal of Practical Medicine, 2024, 40(4): 496-502.
[8]	Yichen WANG,Yanwen YAN,Meihui SONG,Xiangjun XUE,Wenguang ZHOU,Yuquan LI,Ling QI,Guanghua LI,Xiangzong ZENG. Clinical significance of HOXB4 gene expression levels in myelodysplastic syndromes [J]. The Journal of Practical Medicine, 2024, 40(3): 321-325.
[9]	Jia CUI,Mingming ZHANG,Na WANG,Wei GAO,Fei LI. Correlation analysis of glucose and lipid metabolism indicators combined with antiphospholipid antibodies on prognosis of patients with atherosclerosis [J]. The Journal of Practical Medicine, 2024, 40(3): 326-329.
[10]	Shuang CHEN,Na YANG,Yudong HUANG,Xiangfeng KONG,Jintao LI,Yizhong TANG,Kexiong MA,Yangyang ZHANG,Yuandong ZHANG,Chengde REN. Relationship between serum miR-21 and miR-27b levels and prognosis of patients with renal clear cell carcinoma [J]. The Journal of Practical Medicine, 2024, 40(3): 343-348.
[11]	Jian ZHAO,Songjie LIU,Guanchao ZHANG,Yuhou SHEN,Fengchen LI,Bing XU. Expression of CENPF and miR⁃1⁃3p in the serum of patients with advanced gastric cancer and their correlation with prognosis [J]. The Journal of Practical Medicine, 2024, 40(3): 365-370.
[12]	Hongmei ZHU,Yongjiu HUANG,Jiusheng CHU,Xiuhong. PANG. Expression level of neutrophil/lymphocyte ratio and monocyte/high density lipoprotein cholesterol ratio in patients with sudden deafness and their correlation with prognosis [J]. The Journal of Practical Medicine, 2024, 40(24): 3503-3508.
[13]	Ziming ZHAO,Qi MA,Jian CHEN,Yuan CHEN,Liuyi CUI,Yujie. ZHAO. Effects of semaglutide on prognosis in patients with diabetes mellitus complicated with unstable angina after percutaneous coronary intervention [J]. The Journal of Practical Medicine, 2024, 40(24): 3515-3520.
[14]	Hang DENG,Hao. ZHANG. Clinical application of hepatocellular carcinoma prediction models： current challenges and future directions [J]. The Journal of Practical Medicine, 2024, 40(24): 3561-3567.
[15]	Shaohui LIU,Xi WU,Siyuan WEI,Zhixin WU,Shaojuan HUANG,Yi SU,Yuanyi LI,Wending FAN,Qingyu. WU. The relationship between AGI event grading and short⁃term prognosis in patients with acute ischemic stroke of different severity levels [J]. The Journal of Practical Medicine, 2024, 40(23): 3323-3330.