超声结合视频脑电图在早产儿脑损伤早期诊断及预后评价中的应用

Application of ultrasound combined with video electroencephalogram in early diagnosis of brain development,brain injury and prognosis evaluation in premature infants

目的探讨超声结合视频脑电图(VEEG)在早产儿脑损伤早期诊断及预后评价中的应用价值。方法选取出生后由产科转入新生儿重症监护室(NICU)的53例早产儿为研究对象,收集其临床资料,根据早产儿临床表现,将出生时Apgar评分低于7分、10d后经MRI检查确认有脑损伤改变的早产儿作为脑损伤组(n=24),其他设为无脑损伤组(n=29),所有早产儿出生后48h^72h均进行颅脑超声检查,且在床旁进行VEEG监测。结果超声诊断无脑损伤30例,脑损伤23例。VEEG监测显示脑损伤组及无脑损伤组分别有19例、5例早产儿出现脑电异常情况,脑损伤组VEEG脑电图异常率显著高于无脑损伤组(P<0.05)。超声对早产儿脑损伤早期诊断的灵敏度、特异度、准确度分别为83.33%、89.66%、86.79%;VEEG对早产儿脑损伤早期诊断的灵敏度、特异度、准确度依次为79.17%、82.76%、81.13%;超声结合VEEG对早产儿脑损伤早期诊断的灵敏度、特异度、准确度分别为95.83%、96.55%、96.23%,均高于单纯超声和单纯VEEG检测(P<0.05)。随访结果显示,12月龄时,超声结合VEEG诊断为脑损伤的早产儿MDI、PDI评分均较超声结合VEEG诊断为无脑损伤的早产儿低(P<0.05),脑瘫、癫痫发生率均较其高(P<0.05)。结论超声结合VEEG能提高早产儿脑损伤早期诊断效能,在其预后评价中具有重要价值,可供临床借鉴。

Objective To explore application value of ultrasound combined with video electroencephalogram(VEEG)in early diagnosis of brain development,brain injury and prognosis evaluation in premature infants.Methods 53 premature infants transferred from obstetrics department to neonatal intensive care unit(NICU)after birth were enrolled.Their clinical data were collected.According to their clinical manifestations,premature infants with Apgar score at birth lower than 7 points and brain injury changes confirmed by MRI examination 10d later were enrolled as brain injury group(n=24),while the others were enrolled as brain non-injury group(n=29).Within 48h-72h after birth,all premature infants underwent craniocerebral ultrasound examination.VEEG monitoring was performed at the bedside.Results Ultrasound diagnosis showed that there were 30 cases without brain injury and 23 cases with brain injury.VEEG monitoring showed that there were 19 cases and 5 cases with EEG abnormalities in brain injury group and brain non-injury group,respectively.The abnormal rate of VEEG in brain injury group was significantly higher than that in brain non-injury group(P<0.05).The sensitivity,specificity and accuracy of ultrasound and VEEG for early diagnosis of brain development and brain injury in premature infants were(83.33%,89.66%,86.79%)and(79.17%,82.76%,81.13%),respectively.The sensitivity,specificity and accuracy of their combination were 95.83%,96.55%and 96.23%,respectively.The follow-up results showed that at 12-month old,MDI and PDI scores in premature infants diagnosed with brain injury by ultrasound combined with VEEG were lower than those without brain injury(P<0.05),while incidence of cerebral palsy and epilepsy was higher than that without brain injury(P<0.05).Conclusion Ultrasound combined with VEEG can improve early diagnosis efficiency for brain development and brain injury in premature infants,which is of important value in prognosis evaluation.