振幅整合脑电图评分系统在胎龄≤32周早产儿脑发育评估中的应用及评价  

Application of Amplitude-Integrated Electroencephalogram Scoring System in Brain Development Assessment in Preterm Neonates Born at≤32 Weeks' Gestation

作　　者：徐文慧[1,2] 刘娜娜 彭斯聪[1] 陈晓 武志红[1] 柳涛[1] XU Wen-hui;LIU Na-na;PENG Si-cong;CHEN Xiao;WU Zhi-hong;LIU Tao(Department of Pediatrics,the First Affiliated Hospital of Nanchang University,Nanchang 330006,China;Department of Pediatrics,Shangrao People’s Hospital,Shangrao 334000,China)

机构地区：[1]南昌大学第一附属医院儿科,南昌330006 [2]上饶市人民医院儿科,江西上饶334000

出　　处：《南昌大学学报（医学版）》2018年第5期40-46,共7页Journal of Nanchang University：Medical Sciences

基　　金：国家自然科学基金(31660289);江西省科技厅科技计划(20151BBG70204)

摘　　要：目的研究振幅整合脑电图(aEEG)评分系统对早产儿脑成熟度评估的应用价值,并探讨围产期相关因素对aEEG评分系统的影响。方法选取2012年1月至2015年3月入住新生儿重症监护病房(NICU)的40例出生胎龄为26～32周的早产儿,首次aEEG监测于生后12h内进行,监测时间至少4h,以后每周监测1次直至出院或至纠正胎龄38周。对每例早产儿的aEEG图形按连续性、睡眠-觉醒周期、下界振幅及带宽4个参数进行赋值评分,同时计算aEEG总分值,并回顾性分析围产期相关因素(性别、Apgar评分、孕母有无妊娠合并症、分娩方式、小于或适于胎龄儿、是否给予机械通气或低流量给氧)对早产儿aEEG评分的影响。结果随着出生胎龄与纠正胎龄的增加,早产儿aEEG总评分及各参数评分值也随之增加,其中以睡眠-觉醒周期评分增加趋势较为显著,而连续性、下界振幅及带宽评分在胎龄29～34周期间增加较快,至35周以后逐渐趋于稳定水平。出生时重度窒息及孕母妊娠期有合并症的早产儿的aEEG总评分明显降低(P<0.05);而随着纠正胎龄的增加,分娩方式、是否小于胎龄儿及生后是否给予机械通气或低流量给氧对脑发育成熟度无明显影响(P>0.05)。结论早产儿aEEG评分系统可用于评价胎龄≤32周早产儿脑发育成熟过程,在分析aEEG评分系统时还应考虑性别、1min Apgar评分及孕母妊娠期是否有合并症等因素的影响。Objective To study the value of amplitude-integrated electroencephalogram(aEEG)scoring system in assessment of cerebral maturity in premature infants,and to investigate the effect of perinatal factors on this scoring system.Methods A total of40premature infants born at26-32weeks’gestation who were admitted to neonatal intensive care unit from January2012to March2015were recruited in this study.The first aEEG was recorded within12hours after birth for at least4hours,and then aEEG monitoring was performed weekly until discharge or corrected gestational age(38weeks).The continuity,sleep-wake cycle,low bound voltage and bandwidth were analyzed and the total score of aEEG was calculated for each infant.Furthermore,the effect of perinatal factors(gender,Apgar score,pregnancy complications,delivery mode,small or appropriate for gestational age infants,mechanical ventilation,low flow oxygen)on the scoring system was analyzed retrospectively.Results The scores for total aEEG and each parameter increased with gestational age and corrected gestational age.The most significant change was found in the score of sleep-wake cycle.The continuity,low bound voltage and bandwidth scores quickly increased at29-34weeks of gestation,and gradually tended to be stable after35weeks.Moreover,the total aEEG score significantly decreased in infants with severe birth asphyxia or maternal pregnancy complications(P<0.05).However,the corrected gestational age,delivery mode,small for gestational age infants,mechanical ventilation or low flow oxygen had no significant effect on brain maturation(P>0.05).Conclusion The aEEG scoring system can objectively evaluate brain maturation in preterm infants born at≤32weeks’gestation.When using this scoring system,we should consider the influential factors such as gender,1-minute Apgar score and maternal pregnancy complications.

关 键 词：振幅整合脑电图评分 早产儿 纠正胎龄 脑发育 

分 类 号：R722.6[医药卫生—儿科]