振幅整合脑电图在儿童重症监护室癫痫发作中的诊断价值

Diagnostic value of amplitude - integrated electroencephalogram for epileptic seizures in pediatric intensive care unit

目的评估振幅整合脑电图（aEEG）在诊断神经重症患儿癫痫发作中的价值。方法回顾性分析2014年1月至12月复旦大学附属儿科医院重症监护室收治的重症神经系统疾病患儿，床旁视频脑电图（VEEG）监测≥4h，以同步VEEG监测为标准，VEEG信号通过脑电图自带软件（GalileoNTPMS）转化成单通道（C3-Cr）aEEG及多通道（F3-F4；C3-CA；P3-P4；T3-T4）aEEG，aEEG和VEEG分开判断，采用Spearman等级相关分析单通道及多通道aEEG结合原始单通道或多通道EEG与VEEG识别癫痫发作及癫痫持续状态（SE）的相关性。结果35例患儿共61例次VEEG监测纳入分析。1．性别分布：男24例，女11例；年龄分布：2个月～1岁12例，〉1—6岁13例，〉6～12岁10例；病因分布：重症病毒性脑炎15例，原发性癫痫、颅内出血各6例，缺氧缺血性脑病5例，其他3例。2．癫痫发作VEEG监测结果分成2组：SE组37例次，其中惊厥性SE19例次，病因以重症病毒性脑炎和癫痫最为常见；非惊厥性sE18例次，病因以重症病毒性脑炎、缺氧缺血性脑病和颅内出血最为常见。非SE组24例次，共监测到118次癫痫发作。3．aEEG对癫痫发作及SE识别的相关性：SE组aEEG与VEEG结果完全一致；非SE组单通道和多通道aEEG识别癫痫发作的敏感性分别为79．66％（94／118例次）和91．53％（108／118例次），2组识别癫痫发作次数与VEEG记录的癫痫发作次数均呈正相关（P=0．837、0．901，P均〈0．01）。结论对于重症神经系统疾病患儿，aEEG可简单而有效地监测癫痫发作，单通道aEEG最适合于SE的监测，增加aEEG导联数有助于提高对癫痫发作识别的敏感性。

Objective To assess the value of amplitude -integrated electroencephalogram（aEEG） in diagnose of epileptic seizure and status epilepticus in pediatric intensive care unit（PICU）. Methods Thirty - five children ad- mitted to Children＇s Hospital of Fudan University from January to December 2014 with severe neurologia situation in PICU were investigated,and bedside video -EEG（VEEG） findings were recorded for more than 4 hours. VEEG signals were transformed into aEEG signals by Galileo NT PMS software ： one - channel aEEG （ C3 - C4）, mutichannel aEEG （F3 -F4;C3 -C4;P3 -P4;T3 -T4） plus original EEG. Electrical seizure activity on VEEG was signed out with re- spect to its occurrence, duration and localization of seizure onset;while aEEG seizure was recorded only during its oc- currence. The relationship between aEEG and VEEG was analyzed by Spearman analysis. Results A total of 61 traces in 35 cases were suitable for analysis. （1） gender： 24 male and 11 female;years of age：12 cases of 2 months - 1 year old, 13 cases 〉 1 -6 years old, 10 cases 〉 6 -12 years old; etiological factors： 15 cases associated with severe viral encephalitis,6 cases associated with epilepsy, 6 cases associated with intracranial hemorrhage, 5 cases associated with hypoxic- ischemic encephalopathy（ HIE）,3 cases with other factors. （2）The results were divided into 2 groups：status epilepticus （SE） group and epileptic seizures group. There were 37 traces in SE group, 19 traces of them were convul- sive SE, and severe viral encephalitis and epilepsy were the most common causes. The other 18 traces were non- con- vulsive SE,the most common causes were severe viral encephalitis, HIE and intracranial hemorrhage. There were 24 traces in non- SE group, and 118 frequencies of epileptic seizures were monitored. （3）The diagnostic value of aEEG for SE and epileptic seizures ：37 traces with status epilepticus on VEEG were all diagnosed as SE on aEEG. For non - SE electrical seizures, the sensitivity of aEEG for detection of electrical seizures was as follows：79.66% （94/118 traces） for one - channel aEEG,91.53% （ 108/118 traces） for multichannel aEEG. Findings from one - channel aEEG and multichannel aEEG were all related to VEEG（p = 0. 837,0. 901, all P 〈 0.01 ）. Conclusions The aEEG is a sim- ple and effective method for monitoring epileptic seizures and SE in PICU. One - channel aEEG is the best method to find SE. It is helpful to increase the numbers of channel in order to find epileptic seizures.