关于早产儿床旁视频脑电图监测方法的探讨

Discussion on the montage methods of bedside video-electroencephalography in preterm infants

目的:探讨更适合新生儿、早产儿床旁视频脑电图(video electroencephalogram,VEEG)监测的导联方法。方法:对22例不同受孕龄的早产儿同时采用单极、平均参考、双极导联进行VEEG监测。将同一时段中产生的伪迹进行分类,并计数每种伪迹,同时从组成早产儿脑电图背景活动的各要素及畸形波形态进行比较分析。结果:单极导联与平均参考及双极导联存在统计学差异的有同化现象(P=0.000、0.000)、电极伪迹(P=0.000、0.000)、环境伪迹(P=0.000、0.001)、心电伪迹(P=0.000)、线路/交流电伪迹(P=0.002、0.004)。而各种脑波的波幅在3种导联中无统计学差异(P=0.172、0.099、0.145),频率均同步一致。另外,平均参考导联记录的脑波形态、位相以及空间分布更接近真实情况,优于双极导联。结论:平均参考导联记录的EEG不仅伪迹较少,而且能更清晰、可靠的反映出早产儿背景活动及异常波的形态。

Objective：To explore the most appropriate montage for bedside video-electroencephalography（VEEG）of neonates and preterm infants. Methods ：VEEG using monopolar,average reference,and bipolar montages were simultaneously recorded for 22 preterm infants with different conceptional ages. In the same time period,the patterns and numbers of artifacts were analyzed. The parameters that constitute of EEG background activity and the morphological characteristics of the deformed slow waves were analyzed and compared in each VEEG. Results：The number of artifacts recorded by monopolar montage was more than that for average reference and bipolar montages. Monopolar montage had significantly more activation（P=0.000,0.000）and artifacts due to electrodes（P=0.000,0.000）,environment（P =0.000,0.001）,cardiac（P =0.000）,and line/electrical noise（P =0.002,0.004）. The amplitudes of the brainwaves for the three montages were similar（P =0.172,0.099,0.145）. And each brainwave was synchronized,with no obvious change in brainwave frequencies. Moreover,the morphology,phase,and spatial distribution of the recorded waves by average reference montage resembled the actual situation,better than the bipolar montage. Conclusion：EEG recorded by average reference montage exhibits fewer artifacts and better represents the background activities and the deformed waves of preterm infants.