新生儿缺氧缺血性脑病神经症状和脑电图改变

CORRELATION BETWEEN NERVOUS SYMPTOMS ELECTROENCEPHALOGRAPHIC CHANGES AND PROGNOSIS IN NEWBORNS WITH HYPOXIC-ISCHEMIC ENCEPHALOPATHY

目的 探讨新生儿缺氧缺血性脑病 (HIE)神经症状和脑电图改变在判定HIE的病情及预后中的作用。方法 选择中、重度HIE患儿分别为 98例和 4 2例 ,入院后由专人逐日检查神经症状及体征 ,计算各项能影响预后因素的敏感度、特异度等指标。 1周内进行脑电图首次描记 ,对异常脑电图患儿治疗 2周后复查。同时对 10 0例患儿进行了随访。结果 1周后神经症状未消失者 ,中度组 2 1例 ,占 2 1.4 % ,重度组 (除外 2 0例在住院期间死亡者 ) 2 2例 ,占 52 .4 % ;脑电图中度组的异常率为 87.76 % ,重度组为 10 0 % ;敏感度、特异度中度组均为 15% ,重度组均为 90 % ;中度组和重度组的正常指数分别为 0 .70和 0 .80。随访结果 ,中度组随访 79例 ,3例死亡 (占 3.8% ) ,9例留有后遗症 (占 11.4 % ) ;重度组随访 2 1例 ,死亡 10例 (占 4 7.6 % ) ,留有后遗症 9例 (占 4 2 .9% )。结论 结合患儿的病情程度、神经症状及脑电图改变对判定HIE患儿的预后有重要意义。HIE的脑电图异常程度与临床分度基本一致 ,病情程度重、1周后神经症状未消失 ,敏感度、特异度 >90 %者的预后差 ,后遗症的发生率高。

Objective To explore the correlation between nervous symptoms,electroencephalographic changes and prognosis in newborns with hypoxic-ischemic encephalopathy(HIE).Methods 98 cases of moderate HIE and 42 cases of severe HIE were divided into Group One and Group Two respectively.The nervous symptoms and body features were checked every day by specified doctors.The sensitivity,specificity and accurate indexes that may affect the prognostic factors were then calculated.The descriptions of electroencephalogram(EEG) were made in the first week.Those who showed abnormal EEG received reexamination and the results were compared with the original EEG.Follow-up surveys were made on 110 cases of HIE.Results Nervous symtoms remained unchanged in 21 cases(21.4%) in Group One,while in 22 cases (52.4%) in Group Two in which 20 died in hospital a week later.The abnormal rate of EEG,the sensitivity,the specificity and the accurate index in Group One were 87.7%,15%,15% and 0.70 respectively,while those in Group Two were 100%,90%,90% and 0.80 respectively.The follow-up surveys showed that 3 cases(3.8%)died and 9(11.4%) suffered from sequelae in Group One and that 10(47.6%) died and 9 cases(11.4%) suffered from sequelae in Group Two.Conclusion The abnormal degree of EEG in patients with HIE has proved to be approximately consistent with the clinical graduation.Patients with severe HIE usually have unchanged symptoms with high sensitivity and specificity.90% of these cases showed unfavorable prognosis and high sick rate of sequalae.General analysis of patients,conditions,nervous symptoms and EEG changes can play an important role in judging the prognosis of patients with HIE.