目的 探讨振幅整合脑电图(aEEG) 监测在晚期早产儿脑白质损伤的早期诊断及预后评估的应用价值,以期为早产儿脑损作的诊治提供参考。方法 选取2016年1月－2017年6月收住安徽医科大学第三附属医院新生儿重症监护病房的34~37周晚期早产儿146例,根据头颅MRI结果分为脑白质损伤组(观察组,66例)及对照组(80例)。比较两组早产儿出生后3 d内aEEG 监测的图形连续性(Co)、睡眠觉醒周期(Cy)、下边界值(LB)、带宽(B)、总分(T)及与相应胎龄aEEG平均分差值均值情况,分析各评分指标对早产儿脑白质损伤的早期诊断价值,以及头颅MRI结果、纠正胎龄12月时Gesell量表结果与aEEG结果的相关性。结果 观察组早产儿aEEG 监测的Cy、B、T评分低于对照组,观察组与相应胎龄正常早产儿aEEG平均分差值高于对照组,差异有统计学意义(P<0.05)。Spearman相关分析显示Cy、LB、B及T评分与MRI结果均显著相关(r=0.261、-0.271、-0.253和-0.184,P<0.05)。aEEG监测结果与头颅MRI检查结果具有显著相关性(χ2=5.547,P=0.019)。aEEG监测结果与纠正年龄12月龄时Gesell量表评价结果具有显著相关性(χ2=5.979,P=0.014)。结论 aEEG 监测对于晚期早产儿脑白质损伤的早期诊断具有重要价值,同时可以有效地评估早产儿近期神经系统发育状况。
Abstract
Objective To investigate the application of amplitude integrated electroencephalogram (aEEG) in early diagnosis of white-matter damage in late preterm infants and its correlation with short-term prognosis of nerve system,in order to provide reference for the treatment of brain damage in preterm infants. Methods Totally 146 late preterm infants with gestational age of 34-37 weeks in Neonatal Intensive Care Unit of the Third Affiliated Hospital of Anhui Medical University were enrolled in this study from January 2016 to June 2017.The participants were divided into white-matter damage (WMD) group (observation group,66 cases) and control group (80 cases) according to the Results of MRI result.The features of aEEG,including continuity (Co),sleep-wake cycling (Cy),amplitude of the lower border (LB),bandwidth span (B),total scores (T) and the difference with the mean total CFM scores were evaluated and compared between the two groups.The diagnosis value of each score index in WMD infants and the correlation of the Results of aEEG with brain MRI and Gesell Developmental Scale(GDS) score at corrected age of 12 months were analyzed. Results Cy,B,T scores were significantly lower in white-matter damage infants,while the differential value of aEEG score in white matter damage infants was signifincantly higher(P<0.05).The Results of brain MRI were correlated with Cy,LB,B and total scores(r=-0.261,-0.271,-0.253,-0.184,P<0.05).Chi-square test analysis indicated that the aEEG monitoring Results were related to cranial MRI examination (χ2=5.547,P=0.014),so was the relationship between aEEG monitoring Results and GDS score (χ2=5.979,P=0.014). Conclusions aEEG monitoring is of good diagnostic value for early white-matter damage in late preterm infants,and it can evaluate the short-term prognosis of preterm infants effectively.
关键词
振幅整合脑电图 /
早产儿 /
脑白质损伤 /
预后
Key words
amplitude-integrated electroencephalogram /
preterm infant /
white-matter damage /
prognosis
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] 中国医师协会新生儿专业委员会.早产儿脑损伤诊断与防治专家共识[J].中国当代儿科杂志,2012,14(12):883-884.
[2] Ingram MCE,Huguenard AL,Miller BA,et al. Poor correlation between head circumference and cranial ultrasound findings in premature infants with intraventricular hemorrhage[J]. J Neurosurg Pediatr,2014,14(2):184-189.
[3] 中华医学会儿科学分会新生儿学组.早产儿脑室周围-脑室内出血与脑室周围白质软化的诊断建议[J].中华儿科杂志,2007,45 (1):34-36.
[4] Naqeeb NA,Edwards AD,Cowan FM,et al. Assessment of neonatal encephalopathy by amplitude-integrated electroencephalography[J]. Pediatrics,1999,103(1):1263-71.
[5] Burdjalov VF,Baumgart S,Spitzer AR. Cerebral function monitoring:a new scoring system for the evaluation of brain maturation in neonates[J]. Pediatrics,2003,112(4):855-861.
[6] 刘茜,王永芹,张永峰,等.振幅整合脑电图对早产儿脑损伤的诊断价值及其影响因素[J].中国当代儿科杂志,2015,17(5):435-439.
[7] 陈丹,毛健,李娟,等.晚期早产儿脑白质损伤临床特点及磁共振影像学发现[J].中国当代儿科杂志,2010,12(5):321-326.
[8] Variane GF,Magalhães M,Gasperine R,et al. Early amplitude-integrated electroencephalography for monitoring neonates at high risk for brain injury[J]. Pediatric,2017,93(5):460-466.
[9] Fogtmann EP,Plomgaard AM,Greisen G,et al. Prognostic accuracy of electroencephalograms in preterm infants:a systematic review[J]. Pediatrics,2017,139(2).
[10] Niemarkt HJ,Jennekens W,Maartens IA,et al. Multi-channel amplitude-integrated EEG characteristics in preterm infants with a normal neurodevelopment at two years of corrected age[J]. Early Ham Dev,2012,87(10):209-216.
[11] Jiang CM,Yang YH,Chen L Q,et al. Early amplitude-integrated EEG monitoring 6 h after birth predicts long-term neurodevelopment of asphyxiated late preterm infants[J].2015,174(8):1043-1052.
[12] Soubasi V,Mitsakis K,Sarafidis K,et al. Early abnormal amplitude-integrated electroencephalography (aEEG) is associated with adverse short-term outcome in premature infants[J]. Eur J Paediatr Neurol,2012,16(6):625-630.
[13] 邓松清,付俊鲜,康琳敏,等. 振幅整合脑电图在早产儿脑损伤早期诊断的研究[J]. 四川大学学报:医学版,2013,44(2):280-283.
[14] 刘云峰,童笑梅,周丛乐,等. 早产儿脑白质损伤程度与早期脑电生理变化关系的研究[J]. 中国当代儿科杂志,2013,15(5):321-326.
[15] Vesoulis ZA,Paul RA,Mitchell TJ,et al. Normative amplitude integrated EEG (aEEG) measures in preterm infants[J].J Perinatol,2015,35(6):428-433.
[16] Song J,Xu F,Wang L,et al. Early amplitude-integrated electroencephalography predicts brain injury and neurological outcome in very preterm infants[J]. Sci Rep,2015,5:13810.
[17] Nunes ML,Khan RL,Gomes FI,et al. Maturational changes of neonatal electroencephalogram:a comparison between intra uterine and extra uterine development[J]. Clinical Neurophysiology,2014,125(6):1121-1128.
[18] Iyer KK,Roberts JA,Hellströmwestas L,et al. Cortical burst dynamics predict clinical outcome early in extremely preterm infants[J].2015,138(Pt 8):2206.
基金
安徽省科技攻关项目(1604a0802093);合肥市重点专科建设资助项目(2016-256-18)
PDF(575 KB)
