基于病理演变的新生儿缺氧缺血性脑病连续脑电监测管理

Navigation of continuous electroencephalography monitoring on hypoxic-ischemic encephalopathy based on the evolution of its pathogenesis

围生期窒息导致的急性缺氧缺血性脑损伤,即缺氧缺血性脑病(HIE),是NICU中连续脑电监测管理的重点疾病。在HIE的全程管理中,连续脑电监测在低温治疗的选择、损伤程度动态评估、惊厥的规范管理与预测远期神经发育结局都具有不可或缺的作用。HIE的病理演变过程具有明显阶段性,各阶段中的脑灌注、脑组织代谢与脑电活动变化密切关联,不同损伤程度与神经病理类型在不同时期的连续脑电监测中均可充分呈现不同的背景电活动与惊厥负荷特征,只有基于连续脑电监测的惊厥诊断与治疗评估,方能科学管理抗发作药物暴露。因此,实现连续脑电监测规范应用是HIE全程管理的关键。

Hypoxic-ischemic encephalopathy(HIE),which is acute hypoxic-ischemic injury due to perinatal asphyxia,is the focus of continuous electroencephalography(EEG)monitoring in NICU.Since the decision-making on therapeutic hypothermia,dynamic evaluation on the severity,precision management on seizures and predicting neurodevelopmental outcome are overwhelmingly dependent on optimal and correct continuous EEG monitoring.The changes of pathology in HIE are characterized by different duration,among which cerebral blood flow,cerebral metabolism and cerebral electric activity are closely linked and interplay.Continuous EEG monitoring on the ongoing changes of pathology will demonstrate distinct characteristics on the severity of background activity,seizures burden which are associated with brain injury patterns,and moreover,real-time recognition of seizures and effectiveness of antiseizure medicine.Therefore,standardization on continuous EEG monitoring takes the key role in the whole treatment of HIE.