检测先心病患儿EEG和BAEP的意义

Significance of electroencephalography and brainstem auditory evoked potentials detection in children with congenital heart disease

目的 评价先心病儿心脏手术前后脑电图 (EEG)、脑干听觉诱发电位 (BAEP)的变化。方法 对 30例先心病儿童术前EEG、BAEP的变化和 2 0例接受不停跳体外循环心内直视手术患儿手术前后EEG、BAEP的动态变化进行对比观察 ,并设 30名健康儿童为对照。结果 ( 1)术前 :①EEG :发绀组 (CCHD)异常率为 80 % ( 8/ 10 ) ,非发绀组 (NCCHD)异常率为 30 % ( 6 / 2 0 ) ,有显著性差异(P <0 .0 5 )。②BAEP :CCHD组异常率为 10 0 % ( 10 / 10 ) ,NCCHD异常率为 6 5 % ( 13/ 2 0 ) ,有显著性差异 (P <0 .0 5 ) ,Ⅴ波潜伏期 (PL)、Ⅲ～Ⅴ、Ⅰ～Ⅴ波峰间潜伏期 (IPL)先心病患儿与对照组比较 ,CCHD组显著延长 (P <0 .0 5 )。③EEG与BAEP :EEG异常者BAEP均异常 ( 10 0 % ) ,EEG正常者BAEP有 5 6 .3 %异常。 ( 2 )手术前后比较 ,EEG和BAEP异常率有显著性差异 (P <0 .0 5 )。结论 ①先心病患儿伴有脑功能异常 ,CCHD较NCCHD为重。②EEG与BAEP均可反映脑功能异常改变但非同步。③术后短期内EEG、BAEP无好转 ,提示脑功能恢复可能需要较长时间。

Objective To evaluate the significance of changes of electroencephalography(EEG),brainstem auditory evoked potential(BAEP) in children with congenital heart disease(CHD) before and after operation. Methods EEG and BAEP were performed in 30 children with CHD before operation and in 20 of them after operation on beating heart with extracorporeal circulation. At the same time,30 healthy children were observed as control. Result (1)Before operation: ①The EEG abnormality rate was 80% in CCHD group and 30% in NCCHD group. There was significant difference between the two groups ( P <0.05). ②The BAEP abnormality rate was 100% in CCHD group and 65% in NCCHD group, there was also significant difference between the two groups ( P <0.05). As CHD patients compared with normal children, V peak latencies(PL), Ⅲ Ⅴ and Ⅰ Ⅴ interpeak latencies (IPL)were significantly prolonged in CCHD ( P <0.05). ③EEG and BAEP: All BAEPs were abnormal in patients with abnormal EEGs, and 56.3% of BAEPs were abnormal in patients with normal EEGs. (2)Comparison between preoperation and postoperation: Abnormality rate in EEG and BAEP showed significant difference( P <0.05). Conclusions (1) CHD complicate with damage to the brain function is more severe in CCHD than in NCCHD. (2)The abnormal changes of EEG and BAEP may not be always synchronous. (3) The facts that EEG and BAEP fails toget better within a short postoperative period usually indicate that the brain function may not be restored immediately after the correction of intracardiac abnormality.