不同Apgar评分新生儿振幅整合脑电图动态监测的临床意义

Clinical value of amplitude-integrated electroencephalogram dynamic monitoring in neonates with dif- ferent Apgar score

目的了解不同Apgar评分新生儿振幅整合脑电图（amplitude-integrated electroenceph-alogram，aEEG）的变化，探讨aEEG对窒息新生儿缺氧缺血性脑病（hypoxic—ischemic encephalopathy，HIE）的诊断价值。方法2010年12月至2011年10月对我院新生儿病房住院的56例不同Apgar评分足月患儿，根据生后1minApgar评分将患儿分为观察组（Apgar评分0～7分）36例，对照组（Apgar评分8—10分）20例。分别在生后6h内、2d、3d、7d对患儿进行aEEG描记，分析aEEG的变化及其对新生儿HIE的诊断价值。结果对照组20例患儿生后6haEEG正常17例（85％）、轻度异常3例（15％），无重度异常；观察组36例患儿中，生后6haEEG正常18例（50％），轻度异常13例（36．1％），重度异常5例（13．9％），观察组aEEG异常率显著高于对照组（x2=5．3，P〈0．001）。观察组36例患儿中，34例诊断为HIE，生后6haEEG监测结果与HIE临床分度有相关性（Spearman等级相关系数为0．867，P〈0．01）。动态aEEG监测56例患儿，生后6h有21例aEEG异常，其中15例（71．4％）患儿于病程48～72haEEG恢复正常，有4例（7．1％）第7天aEEG呈重度异常。结论对足月HIE新生儿进行生后动态aEEG监测，能早期预测HIE病情轻重程度。

Objective To observe the changes of amplitude-integrated electroencephalogram （aEEG） of neonatal asphyxia with different Apgar scores, and to investigate the diagnostic value of aEEG for hypoxic- ischemic encephalopathy（HIE） in neonatal asphyxia. Methods aEEG monitoring were detected on 56 full- term asphyxia neonates who were hospitalized in our neonatal department from Dec 2010 to Oct 2011. Accord- ing to 1 minute Apgar score after birth ,56 cases were divided into two groups：observation group in which 36 cases with Apgar score 0 ~ 7, and control group in which 20 cases with Apgar score 8 - 10. aEEG monitoring was done within 6 h,2 d,3 d,7 d of each neonates after birth,and the changes of aEEG were analyzed and the diagnostic value on HIE were evaluated. Results Among 20 cases in the control group, the aEEG results in 6 hours after birth were 17 cases （85%） had normal aEEG results,3 cases（ 15% ） mildly abnormal,and no one severely abnormal. The aEEG results of patients in observation group（36 cases） were 18 cases（50% ） had nor- mal aEEG results,13 cases（36. 1% ） mildly abnormal,and 5 cases（ 13.9% ） severely abnormal. The abnormal rate in observation group was significantly higher than that of the control group （X^2 =5. 3 ,P 〈0. 001 ）. There were 34 HIE patients in the total 36 cases of observation group, whose aEEG monitoring results in 6 hours after birth were associated with HIE clinical grading（ Spearman＇s rank correlation coefficient was 0. 867 ,P 〈0. 01 ）. Dynamic aEEG monitoring for 56 patients showed that 21 cases had abnormal aEEG in 6 hours after birth,in whom 15 cases（71.4% ） could returned to normal after 48 -72 hours after birth,and there were only 4 case （7.1% ） still had severely abnormal aEEG results in the seventh day after birth. Conclusion The aEEG dy- namic monitoring for full-term HIE neonates after birth enhances early prediction of HIE.