目的 评估振幅整合脑电图(aEEG)在缺氧缺血性脑病(hypoxic-ischemic encephalopathy, HIE)早期诊治及远期预后中的应用价值。方法 选择2010年8月-2013年2月在八一儿童医院NICU住院的120例HIE患儿作为研究对象, 胎龄34～42+2周, 随机分为aEEG观测组及非观测组, 每组60例。两组再根据HIE严重程度分为轻度、中度、重度3个亚组, 每亚组20例。分别在生后第1、3、14及28天等时相点对aEEG观测组HIE患儿进行aEEG监测;在第3、14、28天对各组HIE患儿进行新生儿神经行为测定(NBNA)评分;对出院患者在矫正胎龄12月时进行随访, 内容包括丹佛发育筛查量表(DDST)及预后评估。结果 aEEG与HIE临床分度存在显著正相关(r=0.843, P＜0.01)。在第3天和第14天时相点zEEG观测组与非观测组NBNA评分无统计学意义(P＞0.05), 而在第28天时相点, aEEG观测组与非观测组NBNA评分有统计学意义(P＜0.05)。在第1、3、14及28天时相点, 观测组aEEG与矫正胎龄满12月时预后均存在强正相关(r=0.832、0.857、0.778、0.743, P＜0.01)。aEEG观测组致残率(13.8%)显著低于非观测组(23.2%);aEEG观测组痊愈率(60%)显著高于非观测组(40%);aEEG观测组和;非观测组远期预后有统计学意义(χ2=4.107, P＜0.05)。结论 aEEG与HIE临床分度具有极好的相关性, 可以早期协助诊治HIE;aEEG可以用于预测HIE远期预后。
Abstract
Objective To evaluate the application value of the aEEG in early diagnosis and treatment of hypoxic-ischemic encephalopathy (HIE) and long-term prognosis. Methods A total of 120 cases of newborns with HIE who were hospitalized from August 2010 to February 2013 were selected, and their gestational ages were from 34~42<sup>+2 weeks.120 cases of newborns were randomly dividing into the observation group with aEEG and non-observation group.According to the severity of HIE, each group was divided into mild, moderate, and severe subgroup, each subgroup with 20 cases.aEEG was respectively traced at time points(1, 3, 14 and 28 days) after birth for observation group with aEEG;Two groups of HIE took the Neonatal Behaviral Neurologieal Assessment (NBNA) assessment at time points(3, 14 and 28 days) after birth;follow-up research for two was done groups after corrected gestational age of 12 months, the follow-up investigation including Denver Developmental Screening Test (DDST) and nervous system sequelae. Results There was positive correlation between aEEG and HIE clinical indexing (r= 0.843, P<0.01).At time points(3 and 14 days)after birth, it was not statistically significant for the NBNA score between observation group with aEEG and non-observation group (P＞0.05)while it was statistically significant for the NBNA score between observation group with aEEG and non-observation group at time point 28 day after birth(P＜0.05).At time points (1, 3, 14 and 28 days)after birth, the aEEG results for observation group with aEEG had strong positive correlations with prognosis after corrected gestational age of 12 months(r=0.832, 0.857, 0.778, 0.743, P＜0.01).The disable rate in the observation group with aEEG (13.8%) was significantly lower than that in the non-observation group (23.2%); the cure rate (60%) in the observation group with aEEG was significantly higher than that in the non-observation group (40%).The long-term prognosis of the observation group with aEEG and the non-observation group was statistically significant (χ2= 4.107, P<0.05). Conclusions The aEEG has excellent correlation with HIE clinical indexing, and can assist in early diagnosis and treatment of HIE.aEEG can be used to predict long-term prognosis of HIE.
关键词
振幅整合脑电图 /
新生儿缺氧缺血性脑病 /
早期诊断
Key words
amplitude integrated electroencephalography /
neonatal hypoxic-ischemic encephalopathy /
early diagnosis
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参考文献
[1] Gadzinowski J, Gulczyńska E, Michniewicz B, et al.The use of therapeutic whole body cooling in treating hypoxic-ischemic encephalopathy in the newborn--the first case in Poland[J].Ginekol Pol, 2012, 83(8):630-632.
[2] 邵肖梅, 叶鸿瑁, 丘小汕.实用新生儿学[M].北京:人民卫生出版社, 2011:700-706.
[3] Azzopardi DV, Strohm B, Edwards AD, et al.Moderate hypothermia to treat perinatal asphyxial encephalopathy[J].N Engl J Med, 2009, 361:1349-1355.
[4] 中华医学会儿科学分会新生儿学组.新生儿缺氧缺血性脑病诊断标准[J].中华儿科杂志, 2005, 43(8):58-59.
[5] Van Rooij LG, Toet MC, van Huffelen AC, et al.Effect of treatment of subclinical neonatal seizures detected with aEEG:randomized, controlled tria[J].Pediatrics, 2010, 125(2):e358-366.
[6] Brankica V, Svjetlana MD.The prognostic value of amplitude-integrated electroencephalography in neonates with hypoxic-ischemic encephalopathy[J].Vojnosanitetski Pregled, 2012, 69(6):492-499.
[7] 鲍秀兰, 孙淑英.新生儿行为和0～3岁教育[M].北京:中国商业出版社, 2001:103-105.
[8] 李冬松, 钱铸山.2518例0～3岁儿童DDST测试结果分析[M].按摩与康复医学, 2011, 2(2):248-249.
[9] Utsunomiya H.Diffusion MRI abnormalities in pediatric neurological disorders[J].Brain Dev, 2011, 33(3):235-342.
[10] Barkovich AJ, Miller SP, Bartha A, et al.MR imaging, MR spectroscopy, and diffusion tensor imaging of sequential studies in neonates with ncephalopathy[J].AJNR Am J Neuroradiol, 2006, 27:533-547.
[11] Foreman SW, Thorngate L, Burr RL, et al.Electrode challenges in amplitude-integrated electroencephalography(aEEG):Research application of a novel noninvasive measure of brain function in preterm infants[J].Biol Res Nurs, 2011, 13(3):251-259.
[12] Lawrence R, Mathur A, Nguyen TS, et al.A pilot study of continuous limited-channel aEEG in term infants with encephalopathy[M].J Pediatr, 2009, 154(6) :835-841.
[13] Spitzmiller RE, Phillips T, Meinzen-Derr J, et al.Amplitudeintegrated EEG is useful in predicting neurodevelopmental outcome in full-term infants with hypoxic-ischemic encephalopathy:a meta-analysis[J].J Child Neurol, 2007, 22(9):1069-1078.
[14] Shah PS, Beyene J, To T, et al.Postasphyxial hypoxic-ischemic encephalopathy in neonates:outcome prediction rule within 4 hours of birth[J].Arch Pediatr Adolesc Med, 2006, 160(7):729-736.
[15] Kato T, Okumura A, Hayakawa F, et al.Amplitude-integrated electroencephalography in preterm infants with cystic periventricular leukomalacia[J].Early Hum Dev, 2011, 87(3):217-221.
[16] 施亿赟, 程国强, 邵肖梅, 等.正常足月新生儿振幅整合脑电图特点的多中心研究[M].中国循证儿科杂志, 2009, 4(6):514-519.
[17] 赵莉, 阚清, 邹芸苏, 等.振幅整合脑电图在颅内出血早产儿中应用研究[M].中国实用儿科杂志, 2012, 27(12):925-927.
[18] 黄雪会, 杨明, 陈晓, 等.85例窒息新生儿生后早期振幅整合脑电图特点分析[M].山东医药, 2012, 52(43):44-47.
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