正中神经体感诱发电位对足月缺氧缺血性脑病新生儿运动发育的预测价值  

Predicting motor outcomes by medial nerve somatosensory-evoked potentials in term neonates with hypoxicischemic encephalopathy

作　　者：周俊[1] 张丙宏[1] 张海燕[2] 汪珍珍[2] 严彩霞[1] 

机构地区：[1]武汉大学人民医院儿科,430060 [2]湖北省孝感市中心医院儿科1病区,432000

出　　处：《中华妇幼临床医学杂志（电子版）》2015年第3期76-79,共4页Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition)

基　　金：湖北省青年人才基金项目(QJX2010-60)~~

摘　　要：目的探讨足月新生儿缺氧缺血性脑病(HIE)正中神经体感诱发电位(MNSEP)的主要特征及其对运动发育结局的预测价值。方法选择2012年6月至2013年6月在湖北省孝感市中心医院生后即转入新生儿科住院治疗,并且出院后在本院小儿神经科门诊完成发育随访的51例HIE新生儿为研究对象。分别在其生后第2周及第6周进行MNSEP检测并记录结果,并在患儿年龄为6个月时根据Peabody运动发育量表(2版)(PDMS-2)评价其运动发育结局。计算持续MNSEP异常对运动发育落后(DM)的预测效度。本研究遵循的程序符合湖北省孝感市中心医院人体试验委员会所指定的伦理学标准,得到了该委员会批准,并征得研究对象监护人的知情同意,与之签署临床研究知情同意书。结果 51例患儿年龄为6个月时的PDMS-2评估结果示,DM患儿为21例(41.2%),正常患儿为30例(58.8%)。2次MNSEP(+)且运动发育结局为DM的患儿为18例(35.3%),MNSEP结果对DM的灵敏度为85.7%,特异度为90.0%,阳性预测值为85.7%,阴性预测值为90.0%,其中,表现为单纯持续N20波对称性缺失或波幅下降>50%患儿为12例(66.7%),单纯持续N20波潜伏期延长患儿为4例(22.2%),其他形式持续异常患儿为2例(11.1%)。结论 MNSEP对DM有较好的预测能力,可以在中至重度HIE新生儿住院期间及早期随访中推广应用。Objective To explore the characteristics and prognosis of the medial nerve somatosensoryevoked potentials（MNSEP）in motor development of term neonates with hypoxic ischemic encephalopathy（HIE）.Methods From June 2012 to June 2013,a total of 51 term neonates with HIE who were hospitalized in neonatal pediatric department and clinic follow-up for six months in pediatric neurological rehabilitation at Xiaogan Central Hospital were included in the study.Their waveform by MNSEP at 2weeks and 6weeks after birth were detected and recorded.Their motor quotient were evaluated according to the Peabody Development Motor Scale 2（PDMS-2）at 6 months old. The predictive validity and inducted the characteristics for MNSEP abnormal continuously to delayed motor（DM）were calculated.Results There were 21 HIE neonates（41.2%）were DM at 6months old,while 30 HIE neonates（58.8%）were normal.The MNSEP results showed that 18 DM neonates were both positive at 2weeks and 6weeks after birth.The predictive validity of MNSEP abnormal continuously for DM were as follow：the sensitivity was 85.7%,the specificity was 90.0%,the positive predictive value was 85.7%,and negative predictive value was90.0%.In 18 neonates with MNSEP abnormal continuously,12cases（66.7%）were manifested as N20 missing or amplitude significantly reducing,4cases（22.2%）were manifested as prolongation of N20 peak latencies,2cases（11.1%）were manifested as other abnormal.Conclusions MNSEP abnormal continuously can predict the DM.It is worth to extend in term neonates with moderate to severe HIE hospitalized and followed up in clinic.

关 键 词：诱发电位 运动 正中神经 缺氧缺血 脑 新生儿 

分 类 号：R742[医药卫生—神经病学与精神病学]