振幅整合脑电图对足月窒息新生儿缺氧缺血性脑病程度及预后的预测价值

Predictive value of amplitude-integrated electroencephalogram for the severity and prognosis of hypoxic ischemic encephalopathy in full-term neonates with asphyxia

目的探讨振幅整合脑电图(aEEG)对足月窒息新生儿缺氧缺血性脑病(HIE)程度及预后的预测价值。方法选取2017年1月至2019年1月入住四川省绵阳市妇幼保健计划生育服务中心新生儿科的足月窒息新生儿86例,均在出生后6~12 h内进行aEEG监测。根据病情分为轻度窒息49例、重度窒息37例。其中并发HIE 45例,分为轻度13例、中度23例、重度9例。根据治疗反应综合判断,预后好33例、预后差12例。分析aEEG异常情况对HIE程度及预后的早期预测价值。结果重度窒息组的aEEG背景活动异常率、睡眠觉醒周期(SWC)异常率、惊厥发生率均明显高于轻度窒息组[86.5%(32/37)比14.3%(7/49)、64.9%(24/37)比24.5%(12/49)、48.6%(18/37)比16.3%(8/49)],差异均有统计学意义(均P<0.05)。HIE重度组的aEEG背景异常率、SWC率、惊厥率均明显高于轻度组和中度组[100.0%(9/9)比46.5%(6/13)、91.3%(21/23),100.0%(9/9)比30.8%(4/13)、87.0%(20/23),88.8%(8/9)比0、69.6%(16/23)],差异均有统计学意义(均P<0.05)。HIE预后差组的背景活动异常率、SWC异常率、惊厥发生率均明显高于预后好组[100.0%(12/12)比72.7%(24/33)、91.7%(11/12)比66.7%(22/33)、83.3%(10/12)比42.4%(14/33)],差异均有统计学意义(均P<0.05)。Spearman相关分析显示,HIE病情程度、预后不良均与aEEG异常率有一定相关性(r=0.60、0.71,均P<0.05)。aEEG异常指标中,背景活动异常对足月窒息新生儿发生HIE的敏感度(84.4%)、特异度(97.6%)、阳性预测值(95.0%)及患儿预后差的发生率(100.0%)最高,且正确指数最大(0.82)。结论aEEG对足月窒息新生儿HIE的发生及预后具有重要的预测价值。

Objective To investigate the value of amplitude-integrated electroencephalogram(aEEG)in predicting the severity and prognosis of hypoxic ischemic encephalopathy(HIE)in full-term neonates with asphyxia.Methods From January 2017 to January 2019,86 full-term neonates suffering from asphyxia who underwent aEEG monitoring in 6-12 h after birth in Maternal and Child Health and Family Planning Service Center of Mianyang,Sichuan Province were enrolled.They were divided into mild asphyxia group(49 cases)and severe asphyxia group(37 cases).Forty-five neonates developed HIE,including 13 cases of mild,23 cases of moderate and 9 cases of severe HIE.After comprehensive treatments,33 cases showed good response and 12 cases had poor prognosis.Early predictive value aEEG abnormality for the severity and prognosis of HIE was analyzed.Results Higher abnormal rates of aEEG background patterns and sleep-waking cycle(SWC)and higher incidence of eclampsia were observed with more severe asphyxia[severer asphyxia group vs mild asphyxia group:86.5%(32/37)vs 14.3%(7/49),64.9%(24/37)vs 24.5%(12/49),48.6%(18/37)vs 16.3%(8/49)]and more severe HIE[severe HIE group vs mild and moderate groups:100.0%(9/9)vs 46.5%(6/13),91.3%(21/23);100.0%(9/9)vs 30.8%(4/13),87.0%(20/23);88.8%(8/9)vs 0,69.6%(16/23)]and poorer prognosis[poor prognosis group vs good prognosis group:100.0%(12/12)vs 72.7%(24/33),91.7%(11/12)vs 66.7%(22/33),83.3%(10/12)vs 42.4%(14/33)](all P<0.05).Spearman analysis showed that the severity and prognosis of HIE were correlated with aEEG abnormality(r=0.60,0.71;both P<0.05).Abnormal aEEG background patterns showed the highest sensitivity(84.4%),specificity(97.6%)and positive predictive value(95.0%)for HIE and the highest risk of poor prognosis(100.0%);the correct index was 0.82.Conclusion aEEG shows a good predictive value for HIE in full-term neonates with asphyxia.