早产儿振幅整合脑电图的影响因素

Risk Factors of Amplitude-Integrated Electroencephalography in Preterm Infants

目的探讨早产儿振幅整合脑电图(aEEG)的影响因素。方法在出生12 h内采用NicoletOne脑功能监测仪对71例早产儿进行aEEG描记。根据aEEG背景活动的方式及有无惊厥样活动,将aEEG结果判断为正常和异常aEEG(包括轻度异常及重度异常)。床旁颅脑超声监测脑损伤的发生。分析胎龄、出生体质量、窒息、低氧血症、辅助通气及脑损伤对早产儿aEEG的影响。结果 1.早产儿71例中,正常aEEG 40例,异常aEEG 31例。2.胎龄<34周者54例,正常aEEG 25例,异常aEEG 29例(53.7%);≥34周者17例,正常aEEG 15例,异常aEEG 2例(11.8%);2组aEEG异常率比较差异有统计学意义(χ2=9.245 2,P<0.01)。3.出生体质量<1.5 kg者25例,正常aEEG 8例,异常aEEG 17例(68.0%);出生体质量≥1.5 kg者46例,正常aEEG 32例,异常aEEG14例(30.4%);2组aEEG异常率比较差异有统计学意义(χ2=9.291 9,P<0.001)。4.产时有窒息者36例,正常aEEG 15例,异常aEEG 21例(58.3%);无窒息者35例,正常aEEG 25例,异常aEEG 10例(28.6%);2组aEEG异常率比较差异有统计学意义(χ2=6.390 4,P<0.05)。5.低氧血症24例,正常aEEG 16例,异常aEEG 8例(33.3%);无低氧血症者47例,正常aEEG 24例,异常aEEG 23例(48.9%);2组aEEG异常率比较差异无统计学意义(χ2=1.572 4,P>0.05)。6.辅助通气者19例,正常aEEG 8例,异常aEEG 11例(57.9%);未辅助通气者52例,正常aEEG 32例,异常aEEG 20例(38.5%);2组aEEG异常率比较差异无统计学意义(χ2=2.136 4,P>0.05)。7.有脑损伤者51例,正常aEEG 24例,异常aEEG 27例(52.9%);无脑损伤者20例,正常aEEG 16例,异常aEEG 4例(20.0%);2组aEEG异常率比较差异有统计学意义(χ2=6.337 5,P<0.05)。结论胎龄和出生体质量对早产儿aEEG有显著影响。小胎龄、低出生体质量以及出生时窒息和脑损伤的早产儿异常aEEG的发生率高。在分析早产儿aEEG时应考虑胎龄、出生体质量、窒息及脑损伤等生理病理因素的影响。

Objective To evaluate the risk factors of amplitude -integrated electroencephalography （aEEG） in preterm infants. Methods Seventy - one preterm infants were monitored by using NicoletOne within 12 hours after birth. The aEEGs were clkassified into 2 categories （normal aEEG and abnormal aEEG which included mild abnormal aEEG and severe abnormal aEEG） according to the patterns of background activities and presence of seizure activities. The cranial ultrasonography was performed bedside to detect the brain it jury. The effects of gesta- tional age, birth weight, asphyxia, hypoxemia, mechanical ventilation and brain injury on the aEEG in preterm infants were analyzed. Results 1. There were 40 infants with normal aEEG and 31 infants with abnormal aEEG among the 71 preterm infants. 2. Among the 54 infants whose gestational ages were less than 34 weeks ,there were 25 infants with normal aEEG and 29（53.7% ） infants with abnormal aEEG. And among 17 infants whose gestational ages were equal or more than 34 weeks ,there were 15 infants with normal aEEG and 2 （11.8% ） infants with ab- normal aEEG, there was significant difference of abnormal aEEG rate between the both groups（x2 = 9. 245 2 ,P 〈 0.01 ）. 3. Among the 25 in- fants whose birth weights were less than 1.5 kg,there were 8 infants with normal aEEG and 17 （68.0%） infants with abnormal aEEG. And among 46 infants whose birth weights were equal or more than 1.5 kg,there were 32 infants with normal aEEG and 14（30.4% ） infants with abnormal aEEG,there was significant difference of abnormal aEEG rate between the both groups0（2 = 9. 291 9 ,P 〈0. 001 ）. 4. Among the 36 infants with asphyxia at birth,there were 15 infants with normal aEEG and 21 （58.3%） infants with abnormal aEEG. And among 35 infants without asphyxia,there were 25 infants with normal aEEG and 10（28.6% ） infants with abnormal aEEG,there was significant difference of ab- normal aEEG rate between the both groups （X2 = 6. 390 4, P 〈 0.05 ）. 5. Among the 24 infants with hypoxia, there were 16 infants with normal aEEG and 8（33.3% ） infants with abnormal aEEG. And among 47 infants without hypoxia,there were 24 infants with normal aEEG and 23 （48.9%） infants with abnormal aEEG,there was significant difference of abnormal aEEG rate between the both groups（x2 = 1. 572 4 ,P 〉 0.05 ）. 6. Among the 19 infants with mechanical ventilation, there were 8 infants with normal aEEG and 11 （57.9%） infants with abnormal aEEG. And among 52 infants without mechanical ventilation,there were 32 infants with normal aEEG and 20（38.5% ） infants with abnormal aEEG, there was significant difference of abnormal aEEG rate between the both groups （X2 = 2.136 4, P 〉 0.05 ）. 7. Among the 51 infants with brain injury,there were 24 infants with normal aEEG and 27（52.9% ） infants with abnormal aEEG. And among 20 ：nfants without brain inju- ry,there were 16 infants with normal aEEG and 4（20.0% ） infants with abnormal aEEG,there was significant difference of abnormal aEEG rate between the both groups（x2 = 6. 337 5, P 〈 0.05 ）. Conclusions The gestational age and birth weight could iafluence the aEEG in the preterm infants dramatically. The infants with smaller gestational ages,lower birth weight,asphyxia and brain injury had a higher rate of abnormal aEEG. The gestational age,birth weight,asphyxia and brain injury should be considered when the aEEG in preterm infants are analyzed.