本文選題：失匹配負(fù)性波(MMN) + 植物狀態(tài)(VS)　； 參考：《昆明醫(yī)科大學(xué)》2017年碩士論文

【摘要】：[目的]研究失匹配負(fù)性波(Mismatch Negativity,MMN)在昏迷患者意識(shí)水平評(píng)估中的應(yīng)用價(jià)值及MMN振幅值與昏迷恢復(fù)量表(Coma Recovery Scale-Revised,CRS-R)、意識(shí)水平分級(jí)(Level of Consiciousness,LoCs)得分表在評(píng)估昏迷患者意識(shí)水平方面的相關(guān)性。[方法]選取昆明醫(yī)科大學(xué)第一附屬醫(yī)院2015年8月至2017年1月收住急診重癥監(jiān)護(hù)室(Emergency Intensive Care Unit,EICU)的昏迷患者進(jìn)行前瞻性臨床研究,并納入年齡和性別與患者組匹配的17名健康人作為正常組。自患者入EICU72小時(shí)后開(kāi)始每5天監(jiān)測(cè)MMN、并進(jìn)行CRS-R、LoCs評(píng)分,直至患者蘇醒或出院,90天后電話隨訪,根據(jù)患者的意識(shí)水平狀態(tài),將患者分為清醒組、植物狀態(tài)(Vegetative State,VS)組和最小意識(shí)狀態(tài)(Minimally Conscious State,MCS)組,探討MMN振幅值在昏迷患者意識(shí)水平評(píng)估方面的應(yīng)用價(jià)值,并研究MMN振幅值與CRS-R、LoCs得分表在評(píng)估昏迷患者意識(shí)水平方面的相關(guān)性。[結(jié)果]研究結(jié)束時(shí),共納入15名患者數(shù)據(jù)進(jìn)行研究,其中3名患者列入清醒組,8名患者列入VS組,4名患者列入MCS組。與正常組相比,VS和MCS組患者的MMN振幅值有明顯的不同(P0.001);當(dāng)患者從MCS逐漸轉(zhuǎn)為清醒時(shí),與正常組相比,患者的MMN振幅值就不再有明顯的差異了;三個(gè)患者組組間MMN振幅值、LoCs得分、CRS-R總分值差異均有統(tǒng)計(jì)學(xué)意義(P0.001),進(jìn)一步行LSD-t兩兩比較:三組間差異均有統(tǒng)計(jì)學(xué)意義(P0.001);MMN振幅和LoCs得分具有相關(guān)性(r=0.978,P0.001);MMN振幅和CRS-R總分值具有相關(guān)性(r=0.926,P0.001);進(jìn)一步回歸分析,可得到回歸方程Y=0.19+2.37x(其中X=MMN振幅值,Y=LoCs得分值);繪制MMN振幅值的ROC曲線,分析得到:清醒組ROC曲線下面積等于0.93,以3.22μV為最佳臨界值,預(yù)測(cè)清醒的靈敏度為94%,特異度為95%;MCS組ROC曲線下面積等于0.96,以2.23μV為最佳臨界值,預(yù)測(cè)MCS的靈敏度為98%,特異度為99%;VS組ROC曲線下面積等于0.94,以1.21μV為最佳臨界值,預(yù)測(cè)VS的靈敏度為96%,特異度為97%。[結(jié)論]1、隨著MMN振幅值的逐漸增大,昏迷患者意識(shí)水平逐漸好轉(zhuǎn);2、MMN振幅值與LoCs得分和CRS-R總分值在評(píng)估昏迷患者意識(shí)水平方面具有相關(guān)性,可以作為一個(gè)客觀指標(biāo)評(píng)估昏迷患者的意識(shí)水平。
[Abstract]:[objective] to study the application value of mismatched negative wave mismatch Negativityn (MMNs) in evaluating consciousness level of coma patients and the correlation between MMN amplitude and coma recovery scale (Coma Recovery Scale-Revisedger CRS-RN, level of consciousness level of Consiciousnessy LoCs) in evaluating consciousness level of coma patients.[methods] A prospective clinical study was conducted among the coma patients admitted to the Emergency Intensive Care EICU in the first affiliated Hospital of Kunming Medical University from August 2015 to January 2017.17 healthy persons matched with age and gender were included as normal group.MMNs were monitored every 5 days after the patients were admitted to EICU72, and the CRS-RN LoCs scores were scored. The patients were followed up by telephone 90 days after the patients woke up or discharged from the hospital. According to the consciousness level of the patients, the patients were divided into conscious group.To explore the value of MMN amplitude in evaluating consciousness level of coma patients, and to study the correlation between MMN amplitude value and CRS-RnLoCs score table in evaluating consciousness level of coma patients.[results] at the end of the study, a total of 15 patients were included in the study, of which 3 patients were included in the awake group, 8 patients were included in the vs group and 4 patients were included in the MCS group.Compared with the normal group, the MMN amplitudes of the patients with vs and MCS were significantly different from those of the normal group (P 0.001), and when the patients gradually changed from MCS to sober, there was no significant difference in the amplitude of MMN between the patients and the normal group.There were significant differences in MMN amplitudes and CRS-R scores among the three groups. Further comparison of LSD-t was made between the three groups. There was a significant correlation between the amplitude of LSD-t and the LoCs score. There was a correlation between the amplitudes of LoCs and the amplitude of LSD-t and the total score of CRS-R.R = 0.926 (P 0.001); further regression analysis,The regression equation Y ~ (0.19) 2.37 x (where the X=MMN amplitude is 0.19 2.37 x) and the ROC curve of MMN amplitude are drawn. The area under the ROC curve is 0.93, and 3.22 渭 V is the best critical value.The sensitivity of MCS prediction was 940.The area under the ROC curve of 95g MCS group was equal to 0.96.The optimum critical value was 2.23 渭 V, the sensitivity of predicting MCS was 98, the area under the ROC curve of 99v group was 0.94, and 1.21 渭 V was the best critical value.The sensitivity of predicting vs was 96 and the specificity was 97.[conclusion] 1. With the increasing of MMN amplitude, the consciousness level of coma patients improved gradually, and the LoCs score and the total CRS-R score were correlated with the consciousness level of coma patients.It can be used as an objective index to evaluate the consciousness level of coma patients.
【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R459.7

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本文編號(hào)：1731982