76例惊厥新生儿动态脑电图临床分析

Clinical analysis of continuous electroencephalogram in the 76 cases of neonatal seizure

目的探讨新生儿惊厥临床发作停止后的动态脑电图(CEEG)的背景活动、成熟度、EEG惊厥发作等情况,分析期间内在关联性,为减轻惊厥所致的脑损伤提供依据。方法收集2010年1月至2014年12月入住中南大学湘雅二医院新生儿科、符合纳入标准的新生儿,行CEEG检查,记录相关临床资料并进行分析。结果符合纳入标准共76例新生儿,导致新生儿惊厥的主要原因是新生儿缺氧缺血性脑病(HIE)、新生儿颅内出血(ICH)和新生儿化脓性脑膜炎。CEEG正常者7例(9.2%),CEEG轻度异常者56例(73.7%),CEEG中度异常者11例(14.5%),重度异常者2例(2.6%),异常率为90.79%。CEEG背景活动无交替图形(TA)13例(17.1%),偶有TA 14例(18.4%);存在同步性异常10例。共26例存在CEEG成熟迟滞,存在EEG惊厥发作者为69例(90.8%)。睡眠期较觉醒期EEG惊厥发作发生率显著性增高(χ2=74.494,P<0.001),睡眠期EEG惊厥发作与CEEG的同步性异常和成熟迟滞有显著相关性(r=0.369,P=0.001;r=0.331,P=0.004),EEG异常程度与新生儿行为神经评分(NBNA)具有显著负相关关系(r=-0.293,P=0.018),与NBNA中的原始反射评分具有显著负相关关系(r=-0.324,P=0.023),CEEG中背景活动呈现低电压与NBNA具有显著负相关关系(r=-0.608,P<0.001)。结论在新生儿惊厥临床发作控制后,仍存在高比例的CEEG异常和CEEG惊厥发作;CEEG与NBNA在新生儿惊厥中评价脑功能损害具有一致性。

Objective To investigate the background activity,maturation,and electrographic seizure of the continuous electroencephalogram(CEEG) after the cessation of clinical seizures with neonatal seizure,analyze the intrinsic relationship during this period,and provide the basis for relieving brain damage caused by seizure.Methods We retrospectively reviewed the CEEG records of neonatal infants with who admitted to the Department of Neonatology,Second Xiangya Hospital of Central South University between January 2010 and December 2014.CEEGs were monitored in corrected age after the seizure had stopped.The CEEG data were analyzed to assess EEG seizure,brain function and brain development.Results A total of 76 infants were included according to the inclusion criteria.The main etiologies were neonatal hypoxic-ischemic encephalopathy(HIE),intracranial hemorrhage(ICH),and neonatal purulent meningitis.There were 7 cases(9.2%) of normal EEG,56 cases(73.7%) of mild abnormal CEEG,11 cases(14.5%) of moderate abnormal EEG,and 2 cases(3.6%) of severe abnormal EEG,with the abnormal rate of 90.79%.On the CEEG background activity,13(17.1%) had no trace alternant(TA),and 14(18.4%) had occasionally TA.There were 10 cases of synchronous anomaly.Twenty-six infants had delayed CEEG maturation,and 69(90.8%) infants had EEG seizures.The incidence of EEG seizures was significantly higher in the sleep stage than that in the wake stage(χ2=74.494,P<0.001).The EEG seizure in the sleep stage was significantly correlated with abnormal CEEG and delayed CEEG maturation(r=0.369,P=0.001;r=0.331,P=0.004).The abnormal EEG grade was negatively correlated with neonatal behavioral nervous assessment(NBNA)(r=-0.293,P=0.018) and NBNA of primitive reflex(r=-0.324,P=0.023).The low-voltage in the CEEG background activity was negatively correlated with NBNA(r=-0.608,P<0.001).Conclusion Although the clinical seizures are controlled,the high incidence of abnormal CEEG and CEEG seizure still exists.CEEG and NBNA are consistent in the evaluation of the seizure brain injury.