振幅整合脑电图在足月新生儿脑损伤监测中的应用价值

目的：探讨振幅整合脑电图(amplitude-integrated electroencephalography,aEEG)在足月新生儿脑损伤诊断及预后预测中的价值。方法选择2013年11月至2015年4月我院新生儿重症监护病房确诊的130例脑损伤足月新生儿,在入院第1、4、7天行aEEG监测,并将其结果与患儿临床近期预后进行分析。结果130例患儿aEEG波形背景识别：不连续电压109例,连续低电压12例,电静止4例；癫痫性活动33例,爆发抑制15例；睡眠-觉醒周期：32例成熟,54例不成熟,39例无。aEEG异常程度判定：轻度异常70例,重度异常60例,不同病种间差异无统计学意义(x2=6.176,P=0.19)。近期预后：aEEG轻、重度异常患儿分别死亡1例、12例,病死率差异有统计学意义(x2=12.760,P ﹤0.001)；其余患儿随访至6月龄测发育商(developmental quotient,DQ),aEEG轻、重度异常患儿DQ≥85及DQ﹤85者差异有统计学意义(x2=33.195,P﹤0.001)。重度aEEG监测的敏感性68.75%、特异性78.68%、阳性预测值77.19%、阴性预测值70.58%。aEEG 波形异常程度、睡眠-觉醒周期与近期预后等级相关分析提示存在相关性(r=0.505,0.507,均P﹤0.001)。结论 aEEG可用于新生儿脑功能监测,有助于脑损伤早期诊断及近期预后评估。

Application of amplitude-integrated electroencephalography in term neonates with brain injury

Objective To explore the value of amplitude-integrated electroencephalography(aEEG) in diagnosis and prognosis in term newborns with brain injury.Methods One hundred and thirty consecutive patients with brain injury admitted in NICU were prospectively enrolled in the study from Nov 2013to Apr 2015.The monitoring of aEEG was done at 1d,4d,7d,respectively.Clinical data were collected and com-pared with the result of aEEG.Results All the cases of newborns with abnormal aEEG background:discon-tinuous voltage(109cases),continuous low voltage(12cases),flat(4cases).The epileptic activity were re-corded in 33cases,and 15cases showed burst-suppression;sleep wake cycle:mature(32cases),immature (54cases),no sleep wake cycle(39cases).The judgment of abnormal level:70cases had mildly abnormal aEEG,severe abnormalities 60cases,and no significant difference in different types of diseases(x2=6.176, P=0.19).Recent prognosis:the death of mild and severe abnormalities were 1case,12cases,respectively, there were significant differences(x2=12.76,P﹤0.001).Developmental quotient(DQ)of these newborns were followed up for more than 6months,and there were significant differences in mild,severe abnormal aEEG in them with DQ≥85and DQ﹤85(x2=33.195,P﹤0.001).The sensitivity of aEEG in severe abnor-mal aEEG was 68.75%,the specificity was 78.68%,and the positive and negative predictive values of aEEG were 77.19%and 70.58%,respectively.The results of aEEG classification and sleep wake cycle were corre-lated with the prognosis of the patients(r=0.505,0.507,respectively,P﹤0.001).Conclusion aEEG can be used to monitor brain function,and it is helpful to evaluation of early diagnosis and prognosis.