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探讨

Exploring the Predictive Value of Quantitative Electroencephalography Combined with Transcranial Doppler Ultrasound for Delayed Cerebral Ischemia after Aneurysmal Subarachnoid Hemorrhage

摘要: 目的：分析定量脑电图(QEEG)与经颅多普勒超声(TCD)联合预测动脉瘤性蛛网膜下腔出血(Aneurysm Subarachnoid Hemorrhage, aSAH)后迟发性脑缺血(Delayed Cerebral Ischemia, DCI)的价值。方法：选取2024年4月~2025年3月aSAH患者75例，予以回顾研究，连续2周观察DCI情况，比较DCI患者脑电图指标、超声指标与未DCI患者的差异，进行logistic多因素回归分析、ROC曲线分析，评估“QEEG + TCD”预测价值。结果：入院2周内DCI发生22例，发生率29.33%；DCI患者改良Fisher分级Ⅲ级及以上患者占比较高(P < 0.05)；脑电图指标比较，DCI患者DCI患者α变异分级低分级占比、相对α功率、相对β功率、α/δ比值低于未DCI患者(均P < 0.05)；超声指标比较，DCI组舒张期血流速度、收缩期血流速度、平均血流速度、搏动指数高于未DCI患者(均P < 0.05)；检查效能比较，“QEEG + TCD”联合预测效能较高(P < 0.05)。结论：定量脑电图联合经颅多普勒超声可以有效预测动脉瘤蛛网膜下腔出血后迟发性脑缺血，蛛网膜下腔出血分级是影响预后的重要因素。

Abstract: Objective: To analyze the value of combining quantitative electroencephalography (QEEG) and transcranial Doppler ultrasound (TCD) in predicting delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (aSAH). Methods: A total of 75 patients with aSAH from April 2024 to March 2025 were selected for a retrospective study. DCI occurrence was continuously observed for 2 weeks. Differences in EEG and ultrasound indices between DCI and non-DCI patients were compared, followed by logistic multivariate regression analysis and ROC curve analysis to evaluate the predictive value of the combined “QEEG + TCD”. Results: Within 2 weeks of admission, 22 cases of DCI occurred, with an incidence of 29.33%. The proportion of DCI patients with modified Fisher grade III or above was higher (P < 0.05). Comparing EEG indices, DCI patients had lower α variability grading, relative α power, relative β power, and α/δ ratio than non-DCI patients (all P < 0.05). Comparing ultrasound indices, DCI patients had higher diastolic, systolic, and mean blood flow velocities, and pulsatility index than non-DCI patients (all P < 0.05). In terms of examination performance, the combined “QEEG + TCD” had higher predictive efficiency (P < 0.05). Conclusion: Quantitative electroencephalography combined with transcranial Doppler ultrasound can effectively predict delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage, and the subarachnoid hemorrhage grade is an important factor affecting prognosis.