脑电图背景活动对窒息足月新生儿预后评估的研究

目的：新生儿期最常见的脑损伤疾病为新生儿重度窒息后的缺氧缺血性脑病（HIE），可遗留神经系统后遗症。目前对新生儿HIE预后的判断方法除考虑异常围生期因素、常规神经系统体格检查外，只能依赖于颅内超声、CT、MRI等影像学方法，这些方法主要建立在解剖结构改变基础之上，而脑电图则能发现早期的脑功能异常。该研究的目的是通过对足月窒息新生儿脑电图背景活动的研究，检测并评估与窒息新生儿预后相关的参数，并根据数理原理得出并证明这些参数对预后判断的价值。方法：对80名生后24 h至日龄<8 d的足月新生儿（对照组31人，窒息组49人）脑电图进行平行对照的前瞻性分析，并在出院后对窒息组患儿进行6~12个月的随访。结果：①窒息患儿交替性脑电活动期平均阵发性放电间期延长，振幅降低，阵发性活动、异常尖波频率出现率和睡眠周期循环障碍的发生率增加。②对窒息患儿预后判断有重要意义的参数为胎龄、出生体重、脑电活动振幅均值、睡眠循环障碍、影像学异常改变、HIE分级。③出生24 h后脑电图仍表现为平坦波或平坦波伴大量异常放电患儿预后极差。结论：脑电图背景活动是足月窒息新生儿预后判断的有效工具，如结合患儿脑电图背景活动及其胎龄、出生体重、影像学检查、HIE分级等临床指标，可使预后判断更为准确。［中国当代儿科杂志，2007，9（5）：425-428］

Prognostic value of electroencephalographic background patterns in full-term neonates with asphyxia

Objective Severe asphyxia during peripartum may lead to some sequela of the nervous system. Currently the neurologic outcome of asphyxiated neonates is assessed by using imaging techniques such as cranial ultrasound, CT and MRI except for evaluating perinatal abnormal factors and routine physical examinations of nervous system. These assessment approaches are based on the changes of anatomic structures of neonates. Electroencephalography (EEG) can shows early abnormal cerebral functions. This study examined the EEG background activity and investigated the parameters associated with the prognostic assessment in full-term neonates with asphyxia. Methods A standard EEG was recorded in 49 asphyxiated full-term neonates aged from 24 hrs to 8 days. Of the 49 neonates, 14 had concurrent mild, 5 had moderate and 9 had severe hypoxic-ischemic encephalopathy (HIE). Thirty-one aged-matched full-term neonates without asphyxia severed as the control group. Forty-three of 49 asphyxiated neonates were followed-up for neurological development for 6-12 months. Important parameters associated with neurological prognosis were evaluated by the principle of data statistics. Results The mean interburst intervals was prolonged, the amplitude of brain electrical activity during all the states were lower, and the incidence of brief burst and sleep-wake cycle disturbance was higher in the asphyxiated group when compared with the control group (P<0.05). In the follow-up, 4 infants had poor fine motor function and 7 showed retarded psychomotor development in the asphyxiated group. Gestational age, birth weight,amplitude of brain electrical activity, severity of HIE, occurrence of sleep-wake cycle disturbance and imaging abnormality were shown as important parameters for predicting neurological outcomes in asphyxiated neonates. The infants who EEG showed isoelectric tracings or isoelectric tracings accompanied with much abnormal discharge had very poor prognosis. Conclusions EEG background pattern is valuable in predicting neurological outcomes for term neonates with asphyxia. EEG in combination with clinic data such as gestational age, birth weight, imaging examination, and severity of HIE may provide an accurate evaluation of neurological outcome.