睡眠觉醒周期在足月窒息新生儿中的临床应用及在预后预测中的价值

The clinical application of sleep-wake cycle in full-term neonates with asphyxia and the analysis of prognostic value

目的:研究振幅整合脑电图(aEEG)中睡眠觉醒周期(SWC)在足月窒息新生儿脑损伤程度判断中的价值和对神经行为发育结果的预测价值。方法:回顾性分析107名足月窒息新生儿生后3~7 d内24 h脑功能监护结果。据其SWC分为正常SWC组(成熟SWC)和异常SWC组(包括不成熟SWC和无SWC)。并选取足月无窒息及围产期缺氧病史患儿30例为对照组。结果:①SWC异常与窒息程度有统计学意义(P<0.001),窒息程度越重,SWC异常率越高。②SWC异常与新生儿缺氧缺血性脑病(HIE)临床分度有统计学意义(P<0.001),脑损伤程度越重,SWC异常率越高。③SWC异常预测HIE的敏感性67.6%、特异性为91.7%,阳性预测值为79.3%、阴性预测值为85.9%。④SWC成熟程度与神经行为发育预后有统计学意义(P<0.001),SWC越异常发育商越低,预后越差。⑤使用《0-6岁儿童神经心理发育量表》对出院后患儿进行回访,计算发育商。其中对照组发育商均正常。⑥SWC异常预测发育商异常的敏感性为62.5%,特异性87.5%,阳性预测值为58.8%,阴性预测值为89.1%。结论:SWC的存在与否反映了新生儿暴露于缺氧缺血性损伤的严重程度。SWC的异常对预测HIE、异常神经行为发育的特异性较高,阴性预测值较高。

Objective To evaluate the value in determining the degree of brain damage after asphyxia in full-term neonates by the performance of sleep-wake cycle(SWC)of amplitude integrated electroencephalogram(aEEG),and predicting neurobehavioral development results.Method 107 cases of full-term neonates with asphyxia underwent 24-hour brain function monitoring 3~7 days after birth were analyzed retrospectively.They were divided into normal SWC group(mature SWC)and abnormal SWC group(including immature SWC and no SWC)according to their results.Thirty neonates without asphyxia or perinatal anoxia were chosen as the control group.Results①SWC abnormality and Asphyxiation degree were statistically significant(P<0.001).The heavier the degree of asphyxia,the higher the abnormal rate of SWC.②Clinical score of abnormal SWC and HIE was statistically significant(P<0.001).The more severe the brain injury,the higher the abnormal rate of SWC.③The sensitivity and specificity of the abnormal SWC to predict HIE were 67.6%and 91.7%,respectively.The positive predictive value was 79.3%and the negative predictive value was 85.9%.④The maturation degree of SWC and neurobehavioral development prognosis were statistically significant(P<0.001),the more abnormal development of SWC,the lower the prognosis was,the worse the prognosis was.⑤The Neuropsychological Development Scale for children aged 0-6 years was used to conduct follow-up visits for the children after discharge,and the developmental quotient was calculated.The developmental quotient of the control group was normal.⑥The sensitivity,specificity,positive predictive value and negative predictive value of SWC were 62.5%,87.5%,58.8%and 89.1%,respectively,to predict developmental quotient abnormality.Conclusion The presence or absence of SWC reflects the severity of neonatal exposure to hypoxic ischemic injury.The degree of abnormality of SWC is highly specific to predict HIE and abnormal neurobehavioral development,and the negative predictive value is high.