振幅整合脑电图联合新生儿行为神经测定评估新生儿脑功能损伤的回顾性研究

A retrospective study of amplitude integrated electroencephalography with neonatal behavioral neurological assessment for the evaluation of neonatal brain functional injury

目的探讨振幅整合脑电图(amplitude integrated electroencephalography,aEEG)联合新生儿行为神经测定(neonatal behavioral neurological assessment,NBNA)对新生儿脑损伤的诊断价值及相关因素进行回顾性研究。方法选取2017年1月1日-2019年12月30日在(南宁市第二人民医院,广西区妇幼保健院,南宁市妇幼保健院)3家医院新生儿科有脑损伤高危因素的新生儿103例为研究对象,对其进行a EEG监测、Apgar及NBNA评分。分析aEEG及NBNA在脑损伤不同程度的表现及相关性,并探讨Apgar评分与NBNA评分之间相关性。结果新生儿体重、有无睡眠觉醒周期、波形是否连续、与胎龄是否相符、NBNA评分对其脑损伤程度具有显著影响,P<0.05,有统计学意义。Apgar评分与NBNA评分呈显著正相关,且其相关系数随评分时间延长而降低(r=0.376,P<0.01);NANB评分与新生儿脑功能程度呈显著正相关(r=0.388,P<0.01)。此外,多元逐步回归结果显示,是否为多胎妊娠、有无睡眠觉醒周期、NBNA总分及部分疾病诊断类型(新生儿败血症、休克、化脓性脑膜炎)是影响新生儿脑功能程度的主要因素,可解释总变异量为55.1%。结论临床可采用振幅整合脑电图、NBNA及Apgar评分的方法对新生儿的脑功能损伤程度进行综合诊断,并重点评估多胎妊娠、体重异常、Apgar早期评分及NBNA评分低的新生儿,加强对其aEEG图睡眠觉醒周期、波形连续性、与胎龄是否相符特点的关注,以有效预测其临床治疗及远期康复效果。

Objective To study the related factors of neonatal brain function impairment based on amplitude integrated electroencephalogram(aEEG)and neonatal behavioral neurological assessment(NBNA).Methods From January 1,2017 to December30,2019,103 neonates with high risk factors of brain injury in the neonates of three hospitals(Nanning Second People’s Hospital,Guangxi Maternal and Child Health Hospital,Nanning Maternal and Child Health Hospital)were selected as the study subjects,and their aEEG monitoring,Apgar and NBNA scores were performed.To analyze the manifestation and correlation of aEEG and NBNA in different degrees of brain injury,and to explore the correlation between Apgar score and NBNA score.Results Neonatal weight,sleep-wake cycle,waveform continuity,consistent with gestational age and NBNA score had significant effects on the degree of brain injury,P<0.05,which was statistically significant.There was a significant positive correlation between Apgar score and NBNA score,and the correlation coefficient decreased with the extension of scoring time(R=0.376,P<0.01).NANB score was positively correlated with the degree of neonatal brain function(R=0.388,P<0.01).In addition,multiple stepwise regression re sults showed that multiple pregnancy,sleep-wake cycle,NBNA total score and diagnosis types of some diseases(neonatal septicemia,shock,suppurative meningitis)were the main factors affecting the degree of neonatal brain function,which could explain the total variation of 55.1%.Conclu sion Amplitude integrated aEEG,NBNA and Apgar score can be used to diagnose the degree of brain function injury in neonates,and to evaluate the neonates with multiple pregnancy,abnormal body weight,Apgar early score and low NBNA score.Physicians should pay more attention to the sleep awakening cycle,waveform continuity and the characteristics consistent with gestational age,so as to effectively predict the clinical treatment and long-term rehabilitation effect.