基于振幅整合脑电图和样本熵评价不同受孕龄新生儿脑成熟度发育规律

Study on cerebral maturation in neonates with different postmenstrual ages based on amplitude-integrated electroencephalogram and sample entropy

目的采用振幅整合脑电图(aEEG)研究不同受孕龄(PMA)新生儿脑成熟度的发育规律。方法选取无特殊疾病、适于胎龄、PMA24～52周的新生儿为研究对象,根据PMA进行分组。通过aEEG监测仪采集脑电信号,得到aEEG图形,分析活动睡眠(AS)期和安静睡眠(QS)期波幅的变化规律。计算样本熵,观察脑电活动复杂度的变化规律。结果 165例新生儿进入分析。①睡眠周期随PMA的增长逐渐建立。PMA<27周aEEG表现为抑制背景下偶尔出现的爆发活动,无明显睡眠周期;PMA～32周观察到初步的AS期与QS期;PMA>37周,出现明显可辨的AS-QS期交替波形。②随PMA的增加,AS期和QS期的振幅整体呈上升趋势。PMA<37周,振幅逐步增加;PMA～44周振幅维持相对稳定,AS期振幅波动于6～20μV,QS期振幅波动于7～25μV;PMA>44周,AS期和QS期振幅进一步增高。③PMA<32周,随PMA的增加,AS期和QS期的样本熵值(P50)整体呈上升趋势,但数值波动较大,缺乏规律性;随着PMA的增加,样本熵值进一步增加,AS期的样本熵值增加程度高于QS期;PMA～36周样本熵值在AS期和QS期分别达到高峰,且波动幅度减小;PMA>37周AS期和QS期的样本熵值均出现下降趋势,活动形式趋于规律化。结论随着PMA的增加,新生儿脑电生理活动逐步发育成熟。aEEG和样本熵能够反映脑电活动的成熟度,在新生儿脑功能监测中有应用价值。

Objective To investigate cerebral maturation in neonates with different postmenstrual ages（PMA）using amplitude-integrated electroencephalogram（aEEG）.Methods Appropriate gestational age neonates without specific diseases and PMA aged from 24 to 52 weeks were selected and grouped according to PMA.Electroencephalogram（EEG）was collected and aEEG waveform was calculated to analyze EEG amplitude changes and sleeping cycle including active sleep（AS）and quiet sleep（QS）in developing neonates.Sample entropy was calculated from EEG to explore the signal complexity changes during brain maturation.Results One hundred and sixty-five neonates were included（133 cases from the First Hospital of Peking University,12 cases from the Third Hospital of Peking University,20 cases from Austrilia aEEG database）.Study subjects were grouped into〈 27 weeks（12 cases,all from Austrilia aEEG database）,-32 weeks（22 cases,8 from Austrilia aEEG database）,-34 weeks（18 cases）,-36 weeks（24 cases）,-40 weeks（37 cases）,-44 weeks（22 cases）and-52 weeks（30 cases）.①Sleep cycle was maturated with increasing PMA.aEEG showed likely burst suppression pattern without sleep cycle before PMA reached 27 weeks.Immature shaped AS and QS could be observed when PMA reached 32 weeks.Clear sleep cycle,which appeared as alternated AS and QS waveforms,was developed after PMA reached 37 weeks.②aEEG amplitude in AS and QS was increased along with PMA overally.Amplitude was obviously increased before PMA by 37 weeks and after PMA by 44 weeks;aEEG amplitude was stable during 37 weeks to 44 weeks in PMA（6-20 μV in AS and 7-25 μV in QS）.③Sample entropy was increased during cerebral development before PMA by 37 weeks overally with its value enhanced more in AS than in QS.The fluctuation of sample entropy was decreased with increasing PMA.Fluctuated sample entropy could be observed before PMA by 32 weeks.Sample entropy was decreased after PMA by 37 weeks which indicated that electrical activity in neonatal brain tended to be more regular at this time.Conclusions Electrical activity in neonatal brain was maturated with increasing PMA.aEEG was a simplified method with intuitionistic waveform.It was a useful tool for neonatal cerebral function monitoring.