心脏骤停后肌:需要标准化-一项系统性审查和术语研究建议
Pia De Stefano1,2, Markus Leitinger3, Francesco Misirocchi2,4
1EEG & Epilepsy Unit, Department of Clinical Neurosciences, University Hospital of Geneva, Geneva, Switzerland.
Critical care medicine
|January 8, 2025
概括
心脏骤停后的肌肉瘤表现出不同的定义和结果. 脑电图的图案可能有助于分类肌瘤,并预测心脏骤停后患者的恢复.
科学领域:
- 神经学 神经学
- 关键护理医学 关键护理医学
- 临床神经生理学 临床神经生理学
背景情况:
- 在心脏骤停 (CA) 之后的肌肉瘤通常被视为一种统一的疾病.
- 然而,在临床表现,脑电图 (EEG) 发现和预后价值方面存在显著的异质性.
- 这种变化使准确的评估和结果预测变得复杂.
研究的目的:
- 审查现有的定义,EEG特征和与CA后肌细胞结核相关的结果.
- 评估是否需要就肌肉细胞分类达成共识.
- 探索EEG在进一步研究和对CA后肌细胞复原的分层中的潜在作用.
主要方法:
- 使用PubMed,Embase和Cochrane数据库进行了系统的文献审查.
- 包括1966年至2024年5月以英语出版的研究,重点关注在CA后72小时内出现肌,肌状态/肌状态 (MyS/SM),肌状态 (MSE) 或早期兰斯-亚当斯综合征 (eLAS) 的成年患者.
- 数据提取和质量评估使用标准化工具 (纽卡斯尔-太华尺度,柯克兰偏差风险) 进行.
主要成果:
- 涉及3881名患者的119项研究符合纳入标准,突出了定义,EEG和结果的大量异质性.
- 大脑性能类别 (CPC) 评分为1-2 (良好的结果) 有显著差异:肌瘤为9.8%,MyS/SM为5.8%,MSE为5.7%,eLAS为82.0%.
- 脑电图发现与结果相关:CPC 1-2在1.6%的抑制/爆发抑制/无反应脑电图患者中,11.3%的非抑制/非爆发抑制/无反应脑电图患者和SE患者中,22.3%的非抑制/非爆发抑制/无反应脑电图患者没有SE患者中.
结论:
- 后CA肌细胞结核的定义中的异质性导致与患者结局的联系较弱.
- 一种拟议的研究方法涉及根据EEG模式对肌肉细胞进行分类: (1) 肌肉细胞具有抑制/爆破抑制背景EEG, (2) 肌肉细胞具有非抑制/不爆破抑制背景EEG和SE,以及 (3) 肌肉细胞具有非抑制/不爆破抑制背景EEG没有SE.
- 这种分类策略需要在未来的前性研究中进行验证,以提高预后准确性.
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