新生儿胆红素脑病急性期脑功能监测  

Amplitude-integrated electroencephalographic changes in neonates with acute bilirubin encephalopathy

作　　者：罗芳[1] 林慧佳[1] 鲍毓[1] 陈正[1] 马晓路[1] 施丽萍[1] 杜立中[1] 

机构地区：[1]浙江大学医学院附属儿童医院新生儿重症监护病房,杭州310003

出　　处：《中华儿科杂志》2013年第3期221-226,共6页Chinese Journal of Pediatrics

基　　金：浙江省科技厅项目（N20110661-02）

摘　　要：目的探讨振幅整合脑电图（aEEG）在新生儿胆红素脑病急性期的变化以及在其临床诊断、分期以及预后的评估价值。方法对2009年10月至2011年12月，在我院新生儿重症监护病房住院的10例急性胆红素脑病患儿进行以aEEG为主要内容的模块化神经电生理体系的多项脑功能指标监测，将脑功能监测结果与急性胆红素脑病临床分期、脑干诱发电位（BAEP）、头颅MRI表现以及临床随访结果进行比较。结果aEEG波形识别：连续正常电压5例；不连续电压4例；BS＋1例；癫痴性活动记录到8例，单次惊厥2例，反复惊厥2例，癫痫持续状态4例；睡眠觉醒周期（SWC）：2例成熟；5例不成熟；3例无。aEEG波形异常程度判定：正常0；轻度异常者3例；重度异常7例。8例进行BAEP检查异常程度分级：2例为中度异常、6例为重度异常。6例患儿行头颅MRI检查：1例正常，5例苍白球或小脑齿状核的信号改变。双向有序等级资料相关性分析提示aEEG波形异常程度与急性胆红素脑病的临床分期、BAEP分级均存在相关性。aEEG波形轻度异常3例在纠正年龄6月龄infanib评分正常2例，过渡1例；7例aEEG波形重度异常的患儿中死亡1例，失访1例，异常3例（痉挛性四肢运动障碍2例，张力低下1例），过渡2例。结论以aEEG为主要内容的模块化神经电生理体系的多项脑功能指标监测可以用于胆红素脑病急性期的脑功能监测，并与临床分期、BAEP异常分级存在相关性；对临床预后亦有一定的评估价值，有待于增加临床病例进一步证实。Objective To characterize amplitude-integrated electroencephalo graphic （aEEG） traces in neonates with acute bilirubin eneephalopathy （ABE）, explore the value of aEEG in early diagnosis and prediction of neurological outcome of ABE. Method aEEG records of 10 cases with ABE （ Oct 2009- Nov 2011 ） were reviewed to identify neonates with a diagnosis of ABE. Clinical data were collected. The aEEG traces were classified according to background activity （ normal, moderate, or severely abnormal） , presence of seizures and sleep-wake cycling （SWC）. Brainstem auditory evoked potential （BAEP） and magnetic resonance imaging （MRI） were studied. The neuromotor development of survivors with ABE was assessed by using the Infant Neurological International Battery （INFANIB）. Result The characteristics of aEEG tracings in these infants with ABE were shown continuous normal voltage （CNV, n = 5 ）, discontinuous voltage （ DNV, n = 4 ）, discontinuous voltage with burst-suppression （BS） BS ＋ （ n = 1 ） ; mature SWC （n =2）, immature SWC （n =5）, no SWC （n =3） ; 8 infants （80%） had electrical seizures： single seizure（n = 2 ） ; repetitive seizures （ n = 2 ）, and status epilepticus （SE） （ n = 4 ）. Among the 10 infants with ABE, no infants had normal aEEG,3 had mildly abnormal aEEG, and 7 had severely abnormal aEEG. Eight infants accepted BAEP test, 2 were mildly abnormal and 6 were severely abnormal. Six infants accepted MRI, 1 was normal and 5 were abnormal. By chi-square analysis and Spearman rank correlation analysis, the results of aEEG classification were correlated with the phase of ABE and the severity of BAEP. These infants were followed up for more than 6 months （range 6 months to 1 year）. In 3 infants with mildly abnormal aEEG, 2 were normal and 1 was transit in infanib score at 6 months of age. Of 7 infants with severely abnormal aEEG, 1 died, 3 were abnormal （2 Spastic dyskinesia and 1 hypotonia） , 2 were transit in infanib score at 6 mont

关 键 词：脑电描记术 高胆红素血症 脑疾病 代谢性 婴儿 新生 胆红素脑病 

分 类 号：R722.1[医药卫生—儿科]