脑干听觉诱发电位在新生儿缺氧缺血性脑病中的应用价值

Clinical application of brainstem auditory evoked potentials in neonates with hypoxic-ischemic encephalopathy

目的了解脑干听觉诱发电位对评价新生儿缺氧缺血性脑病预后的临床应用价值。方法对67例缺氧缺血性脑病患儿进行脑干听觉诱发电位检测、临床分度及头部CT检查并进行比较,对其中41例脑干听觉诱发电位异常者进行早期干预,随访至1岁,观察脑干听觉诱发电位异常患儿的智力发育情况及预后。结果67例缺氧缺血性脑病患儿脑干听觉诱发电位异常率为61.19%(41/67),分别与临床和CT分度相关(χ2=21.660,35.288;均P=0.000);轻、中、重度缺氧缺血性患儿脑干听觉诱发电位差异主要表现为Ⅴ波异常(χ2=20.659,27.171;均P=0.000)。脑干听觉诱发电位与头部CT检查比较,其灵敏度为80.00%(40/50),特异度94.12%(16/17),阳性诊断符合率为83.58%(56/67)。经早期干预治疗随访1年后仅23.68%(9/38)患儿脑干听觉诱发电位检测呈现异常,主要以Ⅴ波异常为主;DQ值异常者31.58%(12/38),其中9例脑干听觉诱发电位异常,临床分度均为重度。结论脑干听觉诱发电位是一种无创、经济、灵敏度高、可重复性强的检测方法,可作为缺氧缺血性脑病患者病情判断和预后评估的重要指标。

Objective To evaluate the role of brainstem auditory evoked potential （BAEP） in the diagnosis and prognosis of hypoxic-ischemic encephalopathy （HIE）. Methods The HIE clinical grading, BAEP and brain CT scanning were examined and analyzed in 67 neonates with HIE. Forty-one neonates with abnormal BAEP were treated in the early stage and followed up with BAEP and Developmental Quotient （DQ） at lmonth, 3 months, 6 months and 1 year of age. Results Of 67 neonates with HIE, 41 had abnormal BAEP （61.19%）. The rate of abnormal BAEP was positively related to clinical grading and degree on brain CT scan respectively （X^2= 21.660, 35.288; P=0.000, for all）. The major differentiation in BAEP among mild, moderate and severe HIE was on abnormal V wave （X^2=20.659, 27.171; P=0.000, for all）. Compared with brain CT scanning, BAEP achieved a sensitivity of 80.00% （40/50）, a specificity of 94.12% （16/17） and a coincidence rate of 83.58% （56/67） in HIE diagnosis. Of 38 treated neonates followed up to 1 year, 9 had abnormal BAEP and were mainly associated with abnormal V wave （23.28%）, and 12 had abnormal DQ value （31.58%）, among which 9 neonates with both abnormal BAEP and DQ value were graded clinically as severe HIE. Conclusion BAEP is a noninvasive, economical, highly sensitive and repeatable method to determine clinical severity and prognosis in HIE neonates.