脑电图及脑干听觉诱发电位评估高危早产儿脑损伤的价值

The value of electroencephalogram and brain stem auditory evoked potential in assessment of brain injury in high-risk premature infants

目的：通过脑电图、脑干听觉诱发电位（BAEP）判断高危早产儿脑损伤程度,以指导早期进行康复干预及了解预后.方法：选择2008年1月至2009年3月本院出生的362例新生儿,分为足月儿组（198例）和早产儿组（164例）,其中早产儿根据是否存在并发症分为正常早产儿组（68例）和高危早产儿组（96例）,各组在生后48～72 h均进行了脑电图、BAEP两项检查,并比较各组上述两项检查的异常率以判断脑损伤发生率.分别将高危早产儿组和正常早产儿组根据胎龄分为〈32周、32＋1～35周、35＋1～37周组,采用等级相关分析胎龄与脑损伤发生率的关系.结果：足月儿组脑电图异常率明显低于正常早产儿组（21.2%vs 33.8%,P〈0.05）,足月儿组BAEP异常率亦稍低于正常早产儿组（20.2%vs25.7%）,但两组比较差异无统计学意义（P〉0.05）.高危早产儿组脑电图、BAEP异常率分别为78.1%、77.6%,明显高于正常早产儿组和足月儿组（P〈0.05）.高危早产儿及正常早产儿在胎龄〈32周、32＋1～35周、35＋1～37周各组中,脑电图的正常、轻度、重度程度以及BAEP正常、轻、中、重程度所占比例两组比较均有统计学意义（均P〈0.05）;且脑电图和BAEP损伤程度、比率与胎龄呈负相关（r1=-0.315,P1〈0.05;r2=-0.378,P2〈0.05）.结论：早产儿脑电图、BAEP检查有助于早产儿脑损伤的早期诊断、早期干预和评估预后;高危早产儿应定期动态监测脑电图、BAEP,及时评估脑功能状况及指导康复治疗.

Objective： To determine the severity of brain injury in high-risk preterm infants by electroencephalogram （EEG） and brain stem auditory evoked potential （BAEP）, so as to guide early rehabilitation intervention and prediction of prognosis. Methods ：362 newborns in our hospital from January 2008 to March 2009 were divided into the full-term infant group （ 198 cases） and premature infant group （ 164 cases）. The premature infants were subdivided into normal premature group （68 cases ） and high-risk preterm infant group （96 cases） according to presence of complications. All newborns underwent EEG and BAEP in 48 - 72 h after birth. The rate of abnormal findings were compared between the groups to determine the incidence of brain injury. High-risk and normal preterm infants were respectively divided into 〈 32 weeks group,32 ＋1 to 35 weeks group and 35 ＋1 to 37 weeks group according to gestational age, and rank correlation analysis was performed to evaluate the relationship between gestational age and severity of brain injury. Results ： The rate of abnormal EEG in full-term infants was significantly lower than that in the normal premature infant group （21.2% vs 33.8% ,P 〈0.05 ）. The rate of abnormal BAEP in full-term infant group was slightly lower than that in the normal premature infant group （20.2% vs 25.7% ） ; however,no significant difference was noted between the two grouns （P 〉 0. 05）. The rates of abnormal EEG and BAEP in high risk preterm infants （78.1% and 77. 6% respectively） were significantly higher than those in the normal preterm infants or the full-term infants （P 〈 0.05）. Significant difference was observed in rates of normal EEG, mild and severe abnormal EEG, and also in rates of normal BAEP, mild, moderate＇ and severe abnormal BAEPs in sub-groups of high-risk or normal premature infants with gestational age 〈 32 weeks,32 ＋1 to 35 weeks and 35 ＋1 to 37 weeks （ all P 〈0. 05 ）. In addition, severity of brain injury and rates of abnormal EEG and BAEP were negatively correlated with gestational age（ r1 = -0.315,P1 〈 0. 05; r2 = -0. 378, P2 〈0. 05）. Conclusion： EEG and BAEP may be helpful for early diagnosis,intervention and prognosis prediction of brain injury in premature infants. Regular monitoring of EEG and BAEP are advised in high-risk premature infants for timely evaluation of brain function and to guide rehabilitation.