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目的应用无创性脑电阻抗测定探讨急性脑出血患者脑水肿的变化规律及意义。方法分别检测200名健康志愿者和78例脑出血患者的脑电阻抗扰动系数及其动态变化,通过多媒体图像分析系统计算头颅 CT 上血肿和血肿周围水肿的体积,并进行相关分析。结果①健康志愿者左、右大脑半球扰动系数分别为(7.98±0.95)和(8.02±0.71),基本对称(P>0.05)。性别、年龄及3～6 h 连续检测前后对其无明显影响(P>0.05)。②脑出血患者的总体检测阳性率为73.1%。血肿位于基底节区时阳性率最高(83.3%),病灶体积大于20 ml 者阳性率(80.0%～88.9%)明显高于体积小于20 ml 者(48.1%)。③脑出血患者血肿侧扰动系数由低于血肿对侧至逐渐升高并超过血肿对侧,这个“交叉”时间平均为起病后(19.67±11.52)h,在该时间点后血肿周围水肿体积较前明显增大(P<0.05),同时扰动系数亦明显升高(P<0.01)。④起病24 h 内的血肿侧扰动系数变化与血肿体积及血肿周围组织水肿体积无相关关系(P>0.05);而病后3 d 的血肿侧扰动系数变化与血肿周围组织水肿体积具有显著正相关关系(r=0.5977,P<0.01)。结论脑电阻抗测定可较敏感地反映脑出血患者脑水肿的变化,扰动系数越高,则提示脑水肿越重。病灶位于基底节区时检测阳性率最高。该方法为临床上进行动态、床旁连续无创性脑水肿监测提供了新的有意义的手段。
Objective To investigate the changes of cerebral edema in patients with acute cerebral hemorrhage and its significance by noninvasive EEG measurement. Methods The disturbance factors and their dynamic changes of EEG in 200 healthy volunteers and 78 patients with cerebral hemorrhage were detected respectively. The volumes of cranial CT and edema around the hematoma were calculated by using the multimedia image analysis system. Results ① The left and right hemispheric disturbance coefficients of healthy volunteers were (7.98 ± 0.95) and (8.02 ± 0.71), respectively, and were basically symmetrical (P> 0.05). Sex, age and 3 ~ 6 h before and after continuous testing had no significant effect (P> 0.05). ② The overall positive rate of ICH patients was 73.1%. The positive rate of hematoma in basal ganglia was the highest (83.3%). The positive rate (80.0% -88.9%) of lesions with volume larger than 20 ml was significantly higher than that of those with volume less than 20 ml (48.1%). ③ The hematoma-side disturbance coefficient of ICH patients increased gradually from the contralateral to the hematoma side and gradually increased beyond the opposite side of the hematoma. The average time of this “cross” was 19.67 ± 11.52 h after the onset of hematoma The edema volume increased significantly (P <0.05), and the disturbance coefficient also increased significantly (P <0.01). (4) There was no correlation between hematoma-side disturbance coefficient and hematoma volume and hematoma volume around hematoma within 24 hours after onset (P> 0.05); while the disturbance coefficient on the hematoma side 3 days after hemorrhage was significantly correlated with the volume of hematoma around hematoma Correlation (r = 0.5977, P <0.01). Conclusion EEG measurement can reflect the changes of cerebral edema in patients with cerebral hemorrhage more sensitively. The higher the disturbance coefficient, the more severe the brain edema. The detection rate of lesions located in the basal ganglia was the highest. This method provides a new meaningful means for clinical monitoring of bedside continuous non-invasive brain edema.