同步视频脑电图监测下双导振幅整合脑电图诊断新生儿惊厥的价值  

Diagnostic value of two-channel amplitude-integrated electroencephalogram in neonatal seizures with simultaneous video electroencephalogram

作　　者：朱小妹[1] 邱鹏玲[1] 程国强[2] 施亿赟[1] 顾秋芳[2] 曹云[2] 陈天兰[1] 孙道开[1] 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重症监护室,上海201102

出　　处：《中华围产医学杂志》2012年第12期720-726,共7页Chinese Journal of Perinatal Medicine

基　　金：国家自然科学基金（81071116）;上海市科委重大课题（09JC1402700）

摘　　要：目的探讨双导振幅整合脑电图（amplitude—integrated electroencephalogram，aEEG）（C3-C4／T3-T4）附加对应的双导原始脑电图（electroencephalogram，EEG）诊断新生儿惊厥的价值及局限性。方法2011年1月至7月，对66例入住复旦大学附属儿科医院的临床有惊厥发作或可疑惊厥发作的新生儿，进行床旁视频脑电图（videoelectroencephalogram，VEEG）监测，时间≥3h。通过GalileoNTPMS软件将原始EEG转化为3种形式aEEG，即单导aEEG（C3-C4）、单导aEEG（（C3-C4）附加原始EEG、双导aEEG（C3-C4／T3-T4）附加原始EEG。EEG和aEEG分开判读，VEEG需标记电发作（≥10s）起始放电灶及放电持续时间，aEEG只进行电发作标记。以VEEG作为标准，采用Spearman相关分析计算aEEG与VEEG识别电发作的相关性。以敏感性、特异性、阳性预测值、阴性预测值评估aEEG诊断新生儿惊厥的价值及局限性。结果共62例新生儿的脑电图纳入分析。（1）电发作：VEEG发现39例患儿电发作≥1次，其中8例发生癫痫持续状态，31例非癫痫持续状态惊厥。31例非癫痫持续状态惊厥VEEG发现电发作活动累计352次，其中79．3％（279次）以颞中央区为起始放电灶。（2）电发作次数识别敏感性：8例癫痫持续状态，aEEG与VEEG诊断结果一致；VEEG监测到352次非癫痫持续状态电发作，单导aEEG、单导aEEG附加原始EEG和双导aEEG附加原始EEG识别电发作敏感性分别为49．1％（173／352）、54．5％（192／352）和81．2Yoo（286／352），各组识别电发作数和VEEG记录的放电灶记录总数均相关（p=0．790、0．907和0．953，P均〈0．01）。（3）惊厥患儿识别敏感性（≥1次电发作）：单导aEEG、单导aEEG附加原始EEG和双导aEEG附加原始EEG识别惊厥患儿的敏感性分别为66．7％（26／39，95％CI：0．62～0．81）、74．4％（29／39，95％CI：0．78～0．96）和89．7％（35／39，95％CI：0．89～1．0Objective To characterize contemporary electrographic neonatal seizures by video electroencephalogram （VEEG） and to assess the value and the limitations of two-channel （C3-C4/T3- T4 ） amplitude-integrated electroencephalogram （aEEG） plus original EEG signals used to diagnose neonatal seizure with video EEG as a golden standard. Methods Sixty-six neonates admitted to Children＇s Hospital of Fudan University from January 2011 to July 2011 with clinical or suspected clinical seizure were investigated and bedside VEEG were recorded for more than 3 hours. VEEG signals were transformed into three kinds of aEEG signals by Galileo NT PMS software： one-channel aEEG （C3-C4）, one-channel aEEG （C3-C4） plus original EEG, two-channel aEEG （C3-C4/T3 T4 ） plus original EEG. Electrical seizure activity on VEEG was signed out with respect to its occurrence, duration and localization of seizure onset; while aEEG seizure was recorded only with its occurrence.The relationship between aEEG and VEEG was analyzed by Spearman analysis. The value and the limitations of aEEG to diagnose neonatal seizure were evaluated by sensitivity, specificity, positive predictive value and negative predictive value. Results A total of 62 traces were suitable for analysis. （1） VEEG showed 39 seizure activities, among which 8 status epilepticus; and the rest 31 neonates had 352 non-status epilepticus electrical seizures, 79.3%（279/352） of which occurred over the eentrotemporal region. （2） Eight cases with status epilepticus on VEEG were all diagnosed as status epilepticus on aEEG. For non-status epilepticus electrical seizures, the sensitivity of aEEG for detection of electrical seizures was as followed： 49.1%（173/352） for one-channel aEEG, 54. 5%（192/352） for one-channel aEEG plus original EEG, 81.2% （286/353） for two-channel aEEG plus original EEG. Results from one-channel aEEG, one-channel aEEG plus original EEG and two-channel aEEG plus original EEG were all related to VEEG （p = 0. 790, 0. 907 and

关 键 词：发作 癫痫持续状态 脑电描记术 婴儿 新生 

分 类 号：R722.1[医药卫生—儿科]