持续脑功能监测评估亚低温治疗缺氧缺血性脑病新生儿预后的临床价值  

The predictive value of continuous aEEG monitoring for neurodevelopmental outcome in infants with hypoxic ischemie encephalopathy receiving hypothermia treatment

作　　者：宋小燕[1] 陈红武[1] 廖卫华[1] 黄为民[1] 

机构地区：[1]广州市南方医科大学南方医院新生儿科,510515

出　　处：《中华新生儿科杂志（中英文）》2018年第1期7-11,共5页Chinese Journal of Neonatology

基　　金：广东省科技计划项目（20138051000049）

摘　　要：目的探讨持续脑功能监测评估亚低温治疗缺氧缺血性脑病（hypoxic-ischemic encephalopathy，HIE）新生儿预后的临床价值。方法选择2014年4月至2016年5月本院新生儿重症救护中心收治的生后行亚低温治疗的中重度HIE患儿进行回顾性研究。入选患儿均于亚低温治疗前行振幅整合脑电图（amplitude-integrated electroencephalogram，aEEG）监测，根据结果分为中度异常组和重度异常组，并分别于亚低温治疗后24、48、72 h和96 h内观察aEEG恢复情况。6月龄时采用标准化Bayley婴儿发育量表行神经行为发育评价，通过随访判断神经预后情况。比较不同aEEG恢复时间预测患儿不良预后的敏感度、特异度、阳性预测值、阴性预测值及约登指数，评价不同aEEG恢复情况对中重度HIE患儿不良预后的预测能力。结果共纳入生后行亚低温治疗的中重度HIE患儿30例，中度异常组13例，重度异常组17例。两组患儿性别、胎龄、出生体重、分娩方式差异无统计学意义（P〉0.05）；重度异常组1min Apgar评分、pH、碱剩余低于中度异常组，血乳酸水平高于中度异常组，差异有统计学意义（P〈0.05）。6月龄时神经行为发育评价16例预后不良，14例预后良好。亚低温治疗前aEEG判断患儿神经预后的敏感度和特异度分别为81.3%、71.4%；治疗后24 h及48 h内判断患儿神经预后的敏感度和阴性预测值最高为100%，但特异度较低（24 h内42.8%、48 h内57.1%）；治疗后72 h内判断患儿神经预后的约登指数最高，为0.661。结论单纯观察亚低温治疗前aEEG情况对治疗后HIE患儿不良预后的预测能力较低，亚低温治疗后72 h内aEEG恢复情况对不良预后的预测能力最高，持续监测HIE患儿aEEG对判断预后有重要的临床价值。Objective To study the predictive value of continuous amplitude-integrated electroencephalogram （aEEG） monitoring for the neurodevelopment outcome in infants with hypoxic-ischemic encephalopathy （HIE） receiving hypothermia treatment. Method From April 2014 to May 2016, neonates admitted to our NICU with HIE receiving hypotbermia treatment were continuously monitored using aEEG for 96 h, and assigned into moderately and severely abnormal groups according to aEEG results. The aEEG results before hypothermia treatment, within 24 h, 48 h, 72 h and 96 h after hypothermia treatment were recorded. The Bayley Scales of Infant Development ]I examination was performed at 6 months of age. The sensitivity, specificity, positive and negative predictive values and Youden＇s index of aEEG for poor outcome at these timepoints was compared. Result A total of 30 neonates were enrolled. Among them 13 were moderately abnormal and 17 were severely abnormal. The gender, gestational age, birth weight and delivery method between two groups were similar （ P 〉 0. 05 ）. The 1 min Apgar score, arterial pH, base excess （BE） were significantly lower in the severely abnormal group （ P 〈 0. 05 ） . The neurodevelopment assessment at 6 months of age showed unfavorable outcomes in 16 cases, while the remaining 14 cases had generally good outcomes. The sensitivity and specificity of aEEG before hypothermia treatment for the prediction of poor outcome was 81.3% and 71.4% respectively. The sensitivity and negative predictive values of aEEG within 24 and 48 after hypothermia treatment for poor outcome was 100%. The Youden＇s index of aEEG within 72 h after hypothermia treatment for abnormal outcome was the highest 0. 661. Conclusion The aEEG before hypothermia treatment alone is not a reliable indicator of poor outcomes in HIE neonates. The aEEG within 72 h after hypothermia is better. Continuous aEEG monitoring during hypothermia in HIE infants is very important because it provides reliable prediction of outcome.

关 键 词：缺氧缺血 脑 神经行为学表现 低温 人工 振幅整合脑电图 预后 

分 类 号：R722.1[医药卫生—儿科]