振幅整合脑电图在窒息新生儿脑损伤中的早期应用

The Early Use of Brain Injury by aEEG in Newborn Asphyxia

目的探讨振幅整合脑电图(a EEG)在窒息新生儿脑损伤早期诊断的应用价值,为指导临床治疗和早期干预提供依据。方法选择2014年1月~2015年12月在潍坊市妇幼保健院NICU住院的50例窒息新生儿作为研究对象,依据病情对全部患儿进行临床分度,分为轻度窒息及重度窒息。对50例窒息新生儿均进行动态a EEG监测,记录出生后6h,3d,7d新生儿振幅整合脑电图(a EEG)检查结果;所有窒息新生儿生后第3d行头颅MRI检查。分析窒息新生儿生后6h内不同程度的a EEG结果与窒息新生儿临床分度的相关性,以及与MRI检查结果的一致性。结果 (1)50例窒息新生儿中,a EEG正常者为13例(26.0%),a EEG轻度异常者为21例(42.0%),a EEG重度异常者为16例(32.0%);轻度窒息新生儿13例(59.1%)a EEG检查结果正常,8例(36.4%)a EEG检查结果轻度异常,1例(4.5%)a EEG检查结果重度异常;重度窒息新生儿13例(46.4%)a EEG检查结果轻度异常,15例(53.6%)a EEG检查结果重度异常。相关性分析结果显示r=0.699,P<0.001。(2)窒息新生儿6h内a EEG正常者为13例(26.0%),a EEG异常者为37例(74.0%),头颅MRI检查结果显示,正常者为20例(40.0%),异常者30例(60.0%)。Kappa等级相关性分析示Kappa值=0.437,P<0.001,差异有统计学意义。结论 6h内a EEG监测结果与窒息临床分度有很好的相关性,6h内a EEG监测结果显示重度异常者窒息程度越重。a EEG监测窒息新生儿脑损伤与头颅MRI监测结果一致性较高。

Objective To expiore the using value of aEEG in early diagnosis of brain injury of asphyxial newborns and provide theoretical basis for guiding the clinical treatment and early intervention.Methods Fifty cases of asphyxial neonates were chosen as the object of study,who were admited in weifang maternity and child carehospital between January 2014 and December 2015.Whole asphyxial neonates were graded clinically according to the condition,including mild and severe asphyxia.The 50 cases of asphyxial newborns all were monitered by dynamic aEEG and the examination results of the aEEG of newborns after the birth of 6h,3d,7d were recorded.On the basis of the aEEG monitoring results.All newborns with asphysia completed MRI examination at 3 days after parturition.Analysised the correlation between the aEEG results of asphysia newborns at 6 hours after birth at different levels and clinical grade of asphyxial neonates as well as consistency with MRI examination results.Results（1）Among 50 cases of asphyxial neonates,normal aEEG was 13 cases（26.0%）,the aEEG with mild abnomality was 21 cases（42.0%）,the severely abnormal aEEG was16 cases.In examination results of aEEG of newborns with mild asphysia,normal results was 13 cases,paranormal results was 8 cases,severely abnormal results was 1 cases.Thirteen cases（46.4%） of aEEG examination results was mildly abnormal and 15 cases（53.6%） of them was severly abnormal amid newborns with severe asphysia.Correlation analysis showed that r=0.699,P〈0.001.（2）The 50 cases of asphyxial newborns were divided into two subgroups by the results of aEEG examination at 6 hours after birth：13 cases（26.0%） of normal aEEG results and 37 cases（74.0%） of abnormal results,who also were separate into two subgroups by head MRI examination results：20 cases（40.0%） of normal head MRI,30 cases（60.0%） of abnormal MRI.Rank correlation analysis of Kappa showed that Kappa=0.437,P〈0.001,which was a significant difference with Kappa value.Conclusion The monitoring results of aEEG within 6 hours had a strong correlation with the clinical grade of asphyxia.The monitoring results of aEEG indicated that the severe abnormalities more serious than others in asphyxial degree.The monitoring results of brain injury by aEEG shows high consistency with the monitoring results by head MRI.