振幅整合脑电图在新生儿脑损伤诊断中的应用

Application of Amplitude-integrated Electroencephalogram on Monitoring Neonatal Brain Injury

目的 探讨振幅整合脑电图在足月儿脑损伤早期诊断方面的临床价值.方法 选取我院新生儿科2014年3月~2016年3月住院的足月窒息新生儿38例为观察组,根据Apgar评分分为轻度窒息组（27例）和重度窒息组（11例）.根据新生儿缺氧缺血性脑病（HIE）诊断标准分为轻度HIE组、中度HIE组和重度HIE组.选择同期在我院产科出生的足月健康新生儿35例为对照组.采用脑功能监护仪于出生后6h内对研究对象进行振幅整合脑电图监测.从背景活动、睡眠-觉醒周期（SWC）及有无癫痫样活动3个方面分析各组振幅整合脑电图结果.结果 对照组新生儿背景活动均正常.轻度窒息组与重度窒息组患儿,轻度HIE组、中度HIE组及重度HIE组患儿背景活动及SWC差异均有统计学意义（P〈0.05）;对照组无癫痫样活动.轻度窒息组患儿偶次痫样放电2例,重度窒息者组患儿偶次痫样放电、反复放电及癫痫持续状态分别为2、3、1例;轻度HIE组患儿偶次痫样放电1例,中度HIE组患儿偶次痫样放电及反复放电分别为3、2例,重度HIE组患儿偶次痫样放电、反复放电及癫痫持续状态分别为1、2、2例;轻度HIE组、中度HIE组及重度HIE组患儿振幅整合脑电图结果差异有统计学意义（P〈0.05）;振幅整合脑电图结果与脑损伤程度呈正相关（r=0.839,P〈0.05）.结论 振幅整合脑电图可早期发现脑损伤,有助于窒息新生儿早期脑损伤的诊断.

Objective To explore the clinical value of amplitude - integrated electroencephalogram on monito- ring neonatal brain injury. Methods 38 cases of full - term newborns with perinatal asphyxia from Mar. 2014 to Mar. 2016 were selected and divided into light asphyxia group（ n = 27 ） and severe asphyxia group（ n = 11 ） by Apgar score. All the cases were divided into mild HIE group, moderate HIE group and severe HIE group by diagnostic standard of HIE. Meanwhile,35 healthy newborns were selected as control group. Within 6 hours after birth, all the cases under- went amplitude - integrated electroencephalographic monitoring by cerebral function monitor. Background activity, SWC and epileptiform activity in the 3 groups were analyzed. Results The background activity in control group was normal. There were significant differences on background activity and SWC among light asphyxia group, severe asphyx- ia group, mild HIE group, moderate HIE group and severe HIE group（ P 〈 0.05 ）. There was no epileptiform activity in control group. In light asphyxia group, there were 2 cases of occasional status epilepticus. In severe asphyxia group, the incidence of occasional status epilepticus,reiterative status epilepticus and status epilepticus were 2 cases,3 cases and 1 case separately. In mild HIE group,there was 1 case of occasional status epilepticus. In moderate HIE group, the in- cidence of occasional status epilepticus and reiterative status were 3 cases and 2 cases. In severe HIE group,the inci- dence of occasional status epilepticus,reiterative status epilepticus and status epilepticus were 1 case, 2 cases and 2 cases separately. There was significant difference on amplitude - integrated electroencephalogram results among mild HIE group,moderate HIE group and severe HIE group（P 〈0.05 ）. There was positive correlation between amplitude - integrated electroencephalogram results and degree of brain injury （ r = 0. 839,P 〈 0. 05 ）. Conclusion Amplitude - inte- grated electroencephalographic monitoring can detect early cerebral injury and help to diagnose neonatal brain injury.