振幅整合脑电图在足月儿缺氧缺血性脑病早期诊断和预后评估的意义

Amplitude-integrated electroencephalographic monitoring in early diagnosis and neurological outcome prediction of term infants with hypoxic-ischemic encephalopathy

目的对足月新生儿缺氧缺血性脑病(HIE)生后6 h 内振幅整合脑电图(aEEG)的变化及其在 HIE 早期诊断和神经学预后评估的价值进行初步探讨。方法对2003年5月至2005年2月间在我院新生儿病房住院的33例足月 HIE 患儿在生后6 h 内进行 aEEG 描记,并将 aEEG 监测结果与 HIE 患儿临床分度及18个月时的神经学预后进行相关性分析,分析其在 HIE 早期诊断和神经学预后预测中的价值。结果 33例 HIE 患儿中,aEEG 正常20例(60.6%),轻度异常5例(15.2%),重度异常8例(24.2%)。33例 HIE 患儿中,轻度 HIE 17例(51.5%),中度 HIE 9例(27.3%),重度HIE 7例(21.2%)。25例进行神经预后分析,其中19例神经学预后正常,1例伤残(智力缺陷),5例死亡。aEEG 分类结果与 HIE 临床分度及其神经学预后均相关性强。aEEG 异常预测新生儿中重度HIE 的敏感性为100%,特异性为81.3%,阳性预测值为85.0%,阴性预测值为100%;预测 HIE 异常神经学预后的敏感性为100%、特异性为90.9%、阳性预测值为93.3%和阴性预测值为100%。结论对足月 HIE 新生儿生后6 h 内 aEEG 监测能早期预测 HIE 病情轻重程度并预测其神经学预后。

Objective To study the changes of the amplitude-integrated electroencephalography （aEEG） tracings within 6 hours after birth in term infants with hypoxic-ischemic encephalopathy （HIE） and explore the value of aEEG in early diagnesis and prediction of neurological outcome in term infants. Methods From May 2003 to February 2005, 33 term infants with HIE at the Division of Neonatology, Pediatric Hospital of Fudan University were studied by aEEG within 6 hours after birth. The results of aEEG were categorized into three groups （normal, mildly abnormal and severely abnormal aEEG）, while HIE was clinically classified into three grades （mild, moderate and severe） and the neurological outcomes at 18 months were assessed （normal, disabled and dead）. The correlation between the results of aEEG, severity of HIE and neurological outcome at 18 months were analyzed, respectively. The values of aEEG on early diagnosis and neurological outcome prediction of HIE were analyzed. Results Among the 33 term infants with HIE, 20 infants had normal aEEG （normal amplitude aEEG）, 5 had mildly abnormal aEEG （4 with mildly abnormal amplitude aEEG, 1 with normal amplitude and seizure） and 8 had severely abnormal aEEG （2 with mildly abnormal aEEG and seizures, 4 with severely abnormal amplitude and 2 with severely abnormal amplitude and seizures）, respectively. Seventeen infants （51.5%） had mild HIE, 19 moderate （27.3%） and 7 （21.2%） severe HIE, respectively. Twenty-five cases were followed up, which showed that 19 had normal neurological outcome, 1 had disability and 5 died. By CMH square analysis and Spearman rank correlation analysis, the results of aEEG classification were correlated with the severity of HIE and the neurological outcome of term infants. Abnormal aEEG could predict the severity of HIE in term infants with a sensitivity of 100%, specificity of 81.3%, positive predictive value of 85.0% and negative predictive value of 100%, respectively. Abnormal aEEG could predict the neurological outcome of term infants with HIE, which showed a sensitivity of 100%, specificity of 90.9%, positive predictive value of 93.3% and negative predictive value of 100%, respectively. Severely abnormal aEEG could predict the severe HIE in term infants with sensitivity of 96.2%, specificity of 100%, positive predictive value of 100% and negative predictive value of 87.5%, respectively. Severely abnormal aEEG could predict the neurological outcome of term infants with HIE, which showed sensitivity of 94.7%, specificity of 100%, positive predictive value of 100% and negative predictive value of 85.7%, respectively. Conclusions Monitoring with aEEG in term infants with HIE within 6 hours after birth could predict the severity of HIE and its neurological outcome at 18 months.