Thompson评分在新生儿缺氧缺血性脑病中的应用

Application of Thompson score in neonatal hypoxic-ischemic encephalopathy

目的探讨出生后早期行Thompson评分在诊断新生儿缺氧缺血性脑病（hypoxic-ischemic encephalopathy,HIE）的程度及预后判断中的价值。方法选择本院存在产时窒息史且出生5小时内出现异常神经系统表现的新生儿进行Thompson评分,并随访动态脑电图（ambulatory electroencephalogram,AEEG）变化。结果 13例新生儿死亡,其Thompson评分均≥21分。相对于Thompson评分〈7分组,Thompson评分≥7分组母亲更容易合并妊娠并发症和（或）产时特殊情况,新生儿1分钟、5分钟Apgar评分更低,更需要持续正压通气、机械通气和药物支持,发展成中重度HIE的比例更高,异常AEEG的比例更多,更易出现严重异常AEEG。Thompson评分预测72小时中重度HIE的灵敏度可达96.9%,特异性为90.9%,预测48~72小时AEEG的灵敏度为94.8%,特异性为73.9%。结论 Thompson评分可作为快速经济预测中重度HIE及异常脑电图的手段。Thompson评分在预测HIE程度上可能较脑电图更经济、更准确、更方便广大临床医生使用。

Objective To explore the value of Thompson score in 5 hours after birth for hypoxic-ischemic encephalopathy （HIE） in early diagnosis, predicting severity and prognosis. Method Prospectively select neonates with birth asphyxia and abnormal nervous system performance in 5 hours after birth in the neonatal department of our hospital. Thompson score at age 3-5 hours and ambulatory electroencephalogram （AEEG） were recorded. Result l 3 patients were dead, with Thompson score all〉 21. As compared with Thompson score〈7, the mothers whose babies with Thompson score〉7 had more pregnancy complications and/or abnormal events during baby birth; the Apgar scores at 1 and 5 minutes were lower; babies need more CPAP, ventilation and medication, more developed to medium-severe HIE, had abnormal AEEG and severely abnormal AEEG. The sensitivity of Thompson score in predicting severe HIE and in predicting the abnormal AEEG outcome are 96.9% and 94.8%; their specificity are 90.9% and 73.9% respectively. Conclusion Thompson score can be used as a method to rapid, economic predict severe HIE and abnormal AEEG. In our study, Thompson score may be more economic, accurately and convenient for clinician in HIE severity prediction than AEEG.