受孕龄28～30周早产儿脑电图高幅慢波改变对其预后的评估价值及临床意义  

Prognostic value and clinical significance of high-amplitude slow wave changes in video electroencephalogram of preterm infants between 28 and 30 weeks of conceptional age

作　　者：唐夕琴[1] 徐娜[1] 黄志[1] 曹洁[1] 包蕾[2] 

机构地区：[1]重庆医科大学附属儿童医院,儿童发育疾病研究教育部重点实验室,儿科学重庆市重点实验室,重庆市儿童发育重大疾病诊治与预防国际科技合作基地,神经内科,重庆400014 [2]重庆医科大学附属儿童医院,儿童发育疾病研究教育部重点实验室,儿科学重庆市重点实验室,重庆市儿童发育重大疾病诊治与预防国际科技合作基地,新生儿科,重庆400014

出　　处：《第三军医大学学报》2013年第15期1624-1628,共5页Journal of Third Military Medical University

摘　　要：目的观察受孕龄(conceptional age,CA)28～30周早产儿脑电图高幅慢波改变情况,探讨其对早产儿预后的评估价值及临床意义。方法 2011年8月至2012年5月我院新生儿重症监护病房收治受孕龄28～30周早产儿34例,于生后1～3 d进行床旁视频脑电图(video electroencephalogram,VEEG)监测,根据受孕龄将受监测者分为受孕龄28～29周及30周2个观察组,根据随访结果又将2个观察组细分为死亡组和存活组,各12例,对每份VEEG记录的暴发间隔时间(interburst interval duration,IBI)及高幅慢波进行20 min半定量分析。结果死亡组与存活组比较,最大IBI时程在受孕龄28～29周及30周均差异显著(P<0.01);高幅慢波主要分布于颞、枕区,形态以光滑δ波占优势,其次为δ刷,波幅以150～300μV为主,在该波幅段优势空间分布及优势波形分布无差异,>300μV慢波在死亡组中数量高于存活组,在空间分布上于颞、枕及前额区有差异(P<0.05),在形态上重叠多高尖波的δ波分布差异最为显著(P<0.01),其次为尖样δ波和δ刷(P<0.05);畸形δ刷、畸形δ波中重叠多高尖波的δ波和一般畸形δ波在死亡组中的发生率均高于存活组(P<0.05)。结论早产儿早期床旁VEEG中IBI时程过长及特殊形态的畸形高幅慢波过多提示脑损伤和/或预后不良发生可能。Objective To observe the variation of high-amplitude slow waves in bedside video electroencephalogram（VEEG） of preterm infants between 28 and 30 weeks of conceptional age（CA）,and to explore the prognostic value and clinical significance.Methods Bedside VEEGs were recorded in 1 to 3 d after birth for all the premature infants between 28 and 30 weeks of CA,who hospitalized in the neonatal intensive care unit from August,2011 to May,2012.According to the CA,the premature infants were divided into 2 groups（28-29 weeks and 30 weeks）,and the two groups were subdivided into a survival group and a death group based on the prognosis.The 20-minute semi-quantitative analysis was carried out in the interburst interval duration（IBI） and the high-amplitude slow waves.Results The maximum IBI was significantly higher in the death group than in the survival group（P 0.01）.At 28 to 30 weeks of CA,high-amplitude slow waves of 150 to 300 μV are numerous and predominant in the temporal and occipital areas.The number of high-amplitude slow waves of 300 μV in the temporal and occipital areas and that in the frontal area at 30 weeks of CA were significantly higher in the death group than in the survival group（P 0.05）.Both deformed delta brushes and delta waves with superimposed high-voltage sharp activity had higher incidence and greater number in the death group than in the survival group（P 0.05）.The incidence of common deformed delta waves and the number of delta waves were greater in the death group than in the survival group as well（P 0.05）.Conclusion Prolonged IBI and excessive special deformed high-amplitude slow waves in the early bedside VEEG of preterm infants may relate to brain injury and poor prognosis.

关 键 词：早产儿 脑电图描记术 暴发间隔时间 高幅慢波 

分 类 号：R722.6[医药卫生—儿科] R741.044[医药卫生—临床医学]