生后6小时床旁视频脑电图诊断围产期缺氧缺血性脑病及其与近期神经行为发育相关性的研究  

Bedside video electroencephalogram within 6 hours after birth in diagnosis of perinatal hypoxic-ischemic encephalopathy and prognosis of short-term neural and behavioral development

作　　者：邱甜[1] 邱鹏玲[1] 陈天兰[1] 孙道开[1] 陈超[2] 王艺[1] 

机构地区：[1]复旦大学附属儿科医院神经科,上海201102 [2]复旦大学附属儿科医院新生儿科,上海201102

出　　处：《中华围产医学杂志》2010年第4期307-313,共7页Chinese Journal of Perinatal Medicine

基　　金：基金项目：上海市科学技术委员会基础重点项目（09JC1402700） 志谢感谢参加随访的儿童和家长对我们工作的信任和支持;感谢我院新生儿科、神经科和儿保康复科所有同仁对于研究工作的精诚合作;对于参与研究的所有评估者深表感谢

摘　　要：目的 探讨新生儿生后6 h床旁视频脑电图（video electroencephalogram,VEEG）对缺氧缺血性脑病（hypoxic-ischemic encephalopathy,HIE）的诊断价值以及与早期神经行为发育结局的相关性.方法 采用前瞻性研究方法,连续纳入2009年3月至9月间我院收治的重度窒息新生儿,记录生后6 h床旁VEEG并分度;以HIE标准诊断方案作为临床诊断HIE和分度的金标准.分析生后6 h不同程度VEEG预测相应程度HIE的敏感性和特异性;在观察者盲法的基础上,比较生后6 h、3和7 d异常VEEG预测HIE的敏感性和特异性.生后7～14 d行新生儿行为神经评分（neonatal behavior neurological assessment,NBNA）,出院后3月龄门诊随访行脑电图（electroencephalogram,EEG）、全身运动（general movements,GMs）质量评估和0～6岁发育筛查测验（developmental screening test for child under six,DST）评估;6月龄行EEG、贝利婴幼儿发展量表（Bayley scales of infant development,BSID）评估,分析6 h VEEG与近期神经发育结局的相关性.结果 重度窒息新生儿48例纳入分析.诊断为单纯重度窒息12例;HIE 36例,其中轻、中和重度分别为14、12和10例.生后6 h VEEG正常9例;异常39例（81.3%）,其中轻、中、重和极重度异常分别为16、11、5和7例.36例HIE新生儿生后6 h VEEG异常32例.异常率88.9%.生后6 h VEEG异常程度与脑损伤程度的等级相关系数为0.849,P〈0.01,生后6 h VEEG重度与极重度异常预测重度HIE敏感性为100%,特异性94.7%;生后6 h、3和7 d VEEG预测HIE的敏感性分别为88.9%、83.9%和28.6%,特异性分别为41.7%、91.7%和100.0%.生后6 h VEEG异常并持续异常于院内死亡9例,生后6 h VEEG中、重度异常者NBNA评分显著低于VEEG正常患儿（P均〈0.01）;VEEG重度异常者NBNA评分显著低于中度异常患儿（P〈0.05）.3月龄时35例患儿来院随访,32例DST〉85分,3例DST 70～84分且伴有EEG异常,其中1例GMs质量评估示不安运动缺乏,提示脑性瘫痪可能性Objective To evaluate the diagnostic value of bedside video electroencephalogram （VEEG） in neonatal within 6 h after birth in diagnosing hypoxic-ischemic encephalopathy （ HIE） and the correlation of bedside VEEG results and early neural and behavioral development. Methods Neonatal severe asphyxia cases were collected and bedside VEEG and HIE were recorded and graduated. The sensitivity and specificity of different VEEG degrees within 6 h after birth were calculated in prognosing HIE degree. The sensitivity and specificity of abnormal VEEG performed within 6 h, the third day and the seventh day after birth, respectively, were compared in prognosing HIE. Neonatal behavior neurological assessment （NBNA） was performed at 7 to 14 days of age, EEG and general movements assessment （GMs）, developmental screening test for child under six（DST） when patients were 3 months old, and EEG, Bayley scales of infant development（BSID） at 6 months old to analyze the correlation of bedside VEEG results and early neural and behavioral development. Results Forty-eight severe asphyxia neonatal were included, among which 12 severe asphyxia and 36 HIE, including 14 mild, 12 moderate and 10 severe HIE. There were nine normal and 39（81. 3%） abnormal VEEG including 16 mild, 11 moderate, five severe abnormal and seven inactive VEEG within 6 h after birth. There were 32（88. 9%） abnormal VEEG within 6 h after birth in 36 HIE patients. Significant positive correlation was found between VEEG within 6 h after birth and HIE （r= 0.849, P〈0. 01）. Severe abnormal and inactive EEG within 6 h after birth showed sensitivity of 100%, specificity of 94. 7% in predicting severe HIE. The sensitivity of VEEG testing at 6 h,3 and 7 d in predicting HIE were 88. 9%, 83. 9% and 28. 6% , correspondingly the specificity were 41.7%, 91. 7% and 100%, respectively. Nine patients with continually abnormal VEEG died in hospital. The NBNA scores of patients with moderate and severe abnormal EEG were significantly lower than those wit

关 键 词：窒息 新生儿 脑电描记术 缺氧缺血 脑 敏感性与特异性 

分 类 号：R742[医药卫生—神经病学与精神病学]