早产儿生后早期振幅整合脑电图特点及其影响因素

Characteristics and its risk fastors of amplitude-integrated electroencephalography in the early brain development of preterm infant

目的：探讨早产儿生后早期脑功能发育特点及其影响因素。方法2009年4月至2013年8月于北京大学第一医院新生儿科就诊的出生胎龄＜37周的早产儿153例，于纠正胎龄足月时（≥38周-＜42周）进行振幅整合脑电图（amplitude-integrated electroencephalography， aEEG）检查。分析早产儿出生胎龄（＜30、30≤-≤33＋6和34≤-≤36＋6周）、临床情况[相对平稳早产儿组（无任何严重合并症及脑损伤者104例）、仅患严重脑损伤组（19例）和仅患严重全身疾病组（30例）]及营养状况（营养良好或营养不良）对aEEG的影响，以及纠正胎龄足月时头颅B超及纠正胎龄6个月后Gesell量表评价与aEEG结果异常的关系。采用χ2检验、两独立样本t检验及Logistic回归分析进行统计学分析。结果纠正胎龄足月时，52%（79/153）的早产儿aEEG达到正常足月儿水平，其余48%（74/153）aEEG异常。相对平稳早产儿随着胎龄增加，aEEG异常率由＜30周组的3/6逐渐降至34≤-≤36＋6周组的35%（13/37），但差异无统计学意义（χ2=1.998， P=0.353）。严重脑损伤组早产儿aEEG结果异常率高于相对平稳早产儿[14/19与44%（46/104），χ2=5.578，P=0.024]。在相对平稳早产儿组，宫内营养不良者的aEEG异常率与营养良好者比较，差异无统计学意义[46%（19/41）与43%（27/63），χ2=0.122，P=0.727]；宫外营养不良者的aEEG异常率与营养良好者比较，差异也无统计学意义[52%（13/25）与42%（33/79），χ2=0.805， P=0.369]。早产儿严重脑损伤是aEEG结果异常的独立危险因素（OR=3.453，95%CI：1.177-10.132， P=0.024）。aEEG检查结果与头颅B超检查结果的符合率为57%（56/98），与Gesell发育量表评估结果符合率为50%（10/20）。结论早产儿生后早期脑功能可能存在追赶性发育，但受到出生胎龄和脑损伤严重程度的影响，结合其他评价方法可共同反映早产儿生后早期神经系统发育情况。

Objective To study the characteristics and its risk fastors of brain development of the preterm infant early after birth in amplitude-integrated electroencephalography（aEEG）. Methods The 153 preterm infants who had seen a doctor in Peking University First Hospital from April 2009 to August 2013 accepted the aEEG check at term of corrected gestational age （ ≥ 38 weeks but 〈 42 weeks of corrected gestational age）. The risk factors of brain development, such as gestational age （ 〈 30, 30 ≤ - ≤ 33＋6 and 34≤-≤36＋6 weeks）, clinical informations [relatively stable group including 104 cases without any serious complications or brain injury, the group only suffering from a serious brain injury （19 cases）, and the group only suffering from severe systemic disease （30 cases）] and nutrition （good or malnutrition）, were analyzed. Also the relationship between the aEEG and the cranial ultrasound detected at the same time and the Gesell Developmental Scale at six months of corrected gestational age. Theχ2 test, two independent samples t-test and＆amp;nbsp;Logistic regression analysis were used for statistical analysis. Results The aEEG of 52%（79/153） cases reached the level of normal full-term newborn at term of corrected gestational age, only 48% （74/153） were abnormal. The abnormal rate of aEEG results in relatively stable preterm infants decreased from 3/6 （〈30 weeks） to 35%（13/37） at 34 ≤ - ≤ 36＋6 weeks, but the difference was not statistically significant （χ2=1.998, P=0.353）. The abnormal rate of aEEG results in the group suffering from a serious brain injury was higher than the relatively stable preterm infants [14/19 vs 44%（46/104） ,χ2=5.578, P=0.024]. In relatively stable preterm infants, there was no difference of the abnormal rate of the aEEG results between intrauterine malnutrition group and good nutrition group [46%（19/41） vs 43%（27/63）,χ2=0.122, P=0.727]. Neither was between extrauterine malnutrition group and good nutrition group [52%（13/25） vs 42%（33/79）,χ2=0.805, P=0.369]. Serious brain injury was independent risk factor of abnormal aEEG （OR=3.453, 95%CI： 1.177-10.132, P=0.024）. The coincidence rate of aEEG and the cranial ultrasound examination or the scores of Gesell Developmental Scale was 57%（56/98） and 50%（10/20）, respectively. Conclusions The brain catch-up development may appears early after birth in preterm infants, which are impaired by lower gestational age and the severe brain injury. It is more effective of aEEG for evaluating the brain development of preterm infants when combines with other methods.