振幅整合脑电图监测不同胎龄早产儿宫外环境下脑发育的多中心观察性研究

目的 了解宫外生活对28~36周早产儿振幅整合脑电图（aEEG）的影响。方法 以出生时无窒息抢救史早产儿为早产儿组，以胎龄37周出生后正常的新生儿为对照组；早产儿组采用振幅整合脑电图仪分别于生后3 d内，然后每周监测1次直至出院（或最长监测至纠正胎龄37周），对照组于生后第3 d 行aEEG监测。每次连续监测4 h。分析胎龄和纠正胎龄对aEEG成熟过程影响，包括aEEG背景连续性、睡眠-觉醒周期、下边界振幅和带宽。5家参研医院均采用相同品牌和型号的aEEG，研究开始前统一进行操作技术培训，样本的临床和图像数据发送至复旦大学附属儿科医院整理。结果 2008年5月1日至2009年8 月31日5家参研医院符合本文纳入和排除标准的早产儿组135例，对照组20例。早产儿aEEG的成熟度受胎龄和纠正胎龄的影响，随胎龄和纠正胎龄增加，aEEG背景连续性和睡眠-觉醒周期出现的百分比均增加，逐步出现连续性电压（χ2=26.865,P<0.01），≥34周出生的早产儿成熟的睡眠-觉醒周期的出现的百分比均为100％（χ2=192.4，P<0.01）；下边界振幅升高（F＝11.4，P<0.01），带宽变窄（F＝8.731,P<0.01）。纠正胎龄和同出生胎龄的新生儿比较，连续性电压百分比、睡眠-觉醒周期的出现率均显著增加，胎龄＞34周的早产儿出生时aEEG均可见明显的睡眠-觉醒周期，而纠正胎龄32周时，睡眠-觉醒周期出现的百分比已达到100%；窄带下界也显著增高；窄带带宽变窄，至34周龄后，纠正胎龄和同出生胎龄新生儿均变化不明显。结论 早产儿aEEG的成熟度与出生胎龄和纠正胎龄相关，宫外生活加速了早产儿脑发育成熟。

Effect of amplitude integrated electroencephalogram on monitoring extrauterine life in preterm infants

Objective To investigate the effect of amplitude integrated electroencephalogram (aEEG) on monitoring extrauterine life in healthy preterm infants with 28 to 36 weeks gestational age (GA).Methods The trail group was the preterm neonates without asphyxia, and the control group was the normal term neonates with GA over 37 weeks. Weekly aEEG recordings were performed on the trail group starting within 3 days after birth until discharged or up to 37 weeks postmenstrual age (PMA). In the control group, aEEG recording was performed on the third day after birth. All the aEEG recordings were continuously monitored for at least 4 hours. Analysis the influence of GA and PMA on the maturation process of aEEG patterns, including the continuity of background potential, the sleep-wake cycling (SWC), the lower border voltage a the bandwidth. The 5 hospitals in research used the same aEEG monitor brand, and received the unified operation training before the study. The data of clinical characteristics and aEEG images were analyzed by Children′s Hospital of Fudan University.Results From May 1, 2008 to August 31, 2009, 135 preterm infants and 20 term infants from 5 hospitals met the inclusion and exclusion criteria. With the increasing GA and PMA, the proportions of aEEG continuity and cycling increased, and appeared the continuous voltage gradually(χ2=26.865,P<0.01), almost all the preterm with GA≥34 weeks had the mature SWC （χ2=192.4，P<0.01）, the lower border of narrow bandwidth was increased （F＝11.4，P<0.01） and the bandwidth narrowing down（F＝8.731,P<0.01）. Compared with the infants with the same GA, the aEEG tracing showed significant increase in the proportions of continuity, the occurrence rate of SWC, the lower border and narrowing bandwidth. The preterm infants with GA≥34 weeks had significant SWC at birth, while the percentage of cycling had reached 100% in the infants with the PMA of 32 weeks. After a PMA of 34 weeks, there was no significant difference between the two groups.Conclusion The maturity of aEEG patterns for preterm infants is related to GA and PMA. The extrauterine life accelerates brain maturation in preterm infants.