脑电活动对高胆红素血症新生儿预后的评估

Prognosis Evaluated with Cerebral Electrical Activity in Neonates with Hyperbilirubinemia

目的研究高胆红素血症足月新生儿的脑电活动,检测和评估与高胆红素血症新生儿预后有关的参数,探讨这些参数对预后判断的价值。方法对31例无高胆红素血症的非神经系统疾病患儿(对照组)和32例高胆红素血症患儿(高胆组)(受孕龄均为37～43周的足月适龄新生儿)的脑电图进行平行对照的前瞻性分析,出生第3个月和第6个月进行神经系统随访。采用判别分析方法,将患儿脑电活动参数值、临床资料与预后建立方程,利用SAS6.12统计软件的逐步判别分析过程,遴选出对预后判断有意义的参数,推导出一组预后判别函数,并采用交叉考核法,判断该函数的正确性。结果1.高胆组患儿脑电活动检查显示,交替性脑电活动期暴发间隔时间延长,清醒期及各睡眠状态下脑电活动振幅均值降低,清醒期前部节律紊乱增多,睡眠循环障碍发生率增高。2.高胆组患儿血浆总胆红素水平与脑电图活动中清醒期前部节律紊乱呈非常显著线性相关。3.对高胆红素血症患儿预后判断有重要意义的参数为患儿的受孕龄、出生体质量、血浆总胆红素水平、TA期暴发间隔、振幅均值、是否出现清醒期前部节律紊乱、非静态睡眠期阵发性活动及睡眠循环障碍。结论脑电图背景活动是足月高胆红素血症新生儿预后判断的有效依据,结合患儿的临床资料及脑电图多项参数进行综合分析,是正确判断预后提的一条新的有效途径。

Objective To investigate the correlation between the plasma unconjugated bilirubin （UCB） and electrical activity of brain in term neonates with hyperbilirubinemia, and explore the parameters that possess the prognostic value and deduce a series of discriminant for prognostic judgment. Methods Thirty-two neonates with hyperbilirubinemia and 31 neonates without hyperbilirubinema （ control group） were studied with standard EEG,and they were assessed for their neurological development in 3 and 6 months. A statistical method of Bayes Discriminant analysis was adopted to set up an equation with values of parameters of EEG, clinic datum and consequence. Stepdic and Disgrim processes were used to pick out the parameters which had. great significance for predicting the outcome of nervous system development. A series of discriminant was deduced for prognostic judgment and then cross validation was performed to assess the accuracy of the discriminant. Results 1. The standard EEG and brain electrical activity map records indicated that the hyperbilirubinemia group had longer maximum duration of interburst interval （IBI）, longer mean duration of IBI, lower amplitude under all conditions, more anterior dysrhythmia （AD） in wake, and higher incidence of sleep-wake cycle disturbance. 2. The plasma concentration of UCB was linear correlated with AD in wake. 3. Gestational age, birth weight,plasma concentration of UCB, burst duration of IBI in trace alternate, amplitude in all sleep state, AD in wake, brief burst not in quiet sleep and sleep-wake cycle disturbance might play important roles in predicting the outcome of neonates with hyperbilirubinemia. Conclusions Cerebral electrical activity is an effective tool for predicting neurologic outcome of neonates with hyperbilirubinemia. Cerebral electrical activity and clinic data will provide a new method for accurately predicting neurological development and prognosis.