振幅整合脑电图在晚期早产儿脑损伤早期诊断及预后评估中的应用价值

Application value of amplitude integrated electroencephalogramin early diagnosis and prognosis evaluation of brain injury in advanced premature infants

目的探讨振幅整合脑电图(aEEG)在晚期早产儿脑损伤早期诊断及预后评估中的应用价值。方法选择2018年8月至2019年8月存在脑损伤高危因素的34~36^(+6)周晚期早产儿80例,根据头颅磁共振(MRI)和神经系统症状分为脑损伤组(35例)和非脑损伤组(45例)。两组均于出生后72 h内行aEEG监测,出生后2周内行头颅MRI检查,纠正胎龄40周行新生儿神经行为测定(NBNA)检测,纠正胎龄6个月时行Gesell发育量表进行测试评估。采用早产儿aEEG评分系统进行评分,校正后总分为相应孕周早产儿总分平均值减原始总分,分析两组aEEG各参数评分及校正后总分、头颅MRI、NBNA及Gesell评分结果与aEEG异常表现的关系。结果脑损伤组aEEG图形连续性、睡眠周期、下边界振幅、波谱带宽度与下边界振幅变化评分明显低于非脑损伤组,差异有统计学意义(P<0.05);脑损伤组aEEG校正后总分高于非脑损伤组,差异有统计学意义(P<0.05);头颅MRI检查结果显示aEEG重度异常组头颅MRI阳性率(100.00%)明显高于aEEG轻度异常组(60.52%),差异有统计学意义(P<0.05);aEEG重度异常组NBNA评分及Gesell评分低于aEEG轻度度异常组,差异有统计学意义(P<0.05)。结论aEEG监测对晚期早产儿脑损伤早期诊断具有重要应用价值,并可预测早产儿近期神经系统发育状况。

Objective To investigate the application value of amplitude integrated electroencephalogram(aEEG)in early diagnosis and prognosis evaluation of brain injury in advanced premature infants.Methods A total of 80 premature infants with high risk factors of brain injury in late 34-36^(+6)weeks admitted to our hospital from August 2018 to August 2019 were selected and divided into the brain injury group(n=35)and the non-brain injury group(n=45)according to magnetic resonance imaging(MRI)and nervous system symptoms.Both groups’aEEGs were monitored within 72 hours after birth and cranial MRIs were performed within 2 weeks after birth.Neonatal behavioral neurological assessment(NBNA)was performed at 40 weeks after corrected gestational age,and Gesell developmental schedules were performed at 6 months after corrected gestational age.The aEEG scoring system for premature infants was used to score.After correction,the total score was the average total score of premature infants in the corresponding gestational weeks minus the original total score.The relationship between aEEG parameter scores,corrected total score,cranial MRI,NBNA and Gesell score and abnormal performance of aEEG was analyzed.Results The scores of aEEG pattern continuity,sleep cycle,lower boundary amplitude,spectral band width and lower boundary amplitude in the brain injury group were significantly lower than those in the non-brain injury group(P<0.05).The corrected total score of aEEG in the brain injury group was higher than that in the non-brain injury group,with statistically significant difference between the two groups(P<0.05).The results of cranial MRI showed that the positive rate of cranial MRI in the severe abnormal aEEG group was 100.00%,which was significantly higher than 60.52%in the mild abnormal aEEG group,with statistically significant difference(P<0.05).The NBNA score and Gesell score in the severe abnormal aEEG group were lower than those in the mild abnormal aEEG group,with statistically significant difference between the two groups(P<0.05).Conclusion AEEG monitoring has important application value in early diagnosis of brain injury in advanced premature infants and can predict the recent development of nervous system of premature infants.