振幅整合脑电图联合新生儿行为神经测定在早产儿脑损伤中的应用价值  

Application value of amplitude integrated electroencephalography(aEEG)combined with neonatal behavioral neurological assessment(NBNA)in brain injury of premature infants

作　　者：史学凯[1] 何潇[1] 吴华[1] 黄玉维 曾贵祥[2] 潘新年[3] 蓝国锋 Shi Xuekai;He Xiao;Wu Hua;Huang Yuwei;Zeng Guixiang;Pan Xinnian;Lan Guofeng(Department of Pediatrics,The Second Nanning People’s Hospital,Nanning 530031,China;Department of Pediatrics,Nanning Maternal&Child Health Hospital,Nanning 530011,China;Department of Pediatrics,The Maternal&Child Hospital of Guangxi Zhuang Autonomous Region,Nanning 530000,China)

机构地区：[1]南宁市第二人民医院儿科,530031 [2]南宁市妇幼保健院儿科,530011 [3]广西壮族自治区妇幼保健院儿科,南宁530000

出　　处：《国际医药卫生导报》2019年第20期3373-3375,共3页International Medicine and Health Guidance News

基　　金：南宁市科学技术局重点研发计划(20173017-4)。

摘　　要：目的评价在对早产儿脑损伤的诊断中,利用振幅整合脑电图(amplitude integrated electroencephalography,aEEG)联合新生儿行为神经测定(Neonatal Behavioral Neurological Assessment,NBNA)的诊断效果和价值表现。方法把从2017年1月至2018年12月本院收入的早产儿218例(胎龄为28~36周),根据有无存在脑损伤因素分为脑损伤组102例,非脑损伤组116例,在早产儿出生后的6 h内,对期间进行aEEG描记的诊断方法,连续记录3 h,并于生后24 h内及第3天进行头颅B超检查,于出院前进行头颅核磁共振成像(Magnetic Resonance Imaging,MRI)检测,并且纠正胎龄40周,进行NBNA评分,并根据aEEG的特点及NBNA评分高低,来对两项评估在早产儿的脑损伤诊断中联合运用的价值和效果。结果临床应用表明,联合利用aEEG及NBNA评分对早产儿的脑损伤程度进行评估,其灵敏度可达91.87%,超过单独应用aEEG的86.31%和单独应用NBNA的76.32%,在特异度表现上,联合应用的特异度为67.53%,低于单独应用aEEG的75.42%和单独应用NBNA的83.67%,联合应用的情况下,ROC曲线下的面积达到0.856,超过独立应用aEEG、NBNA的0.813和0.754。结论联合评估法比单独检测的ROC曲线下面积大,灵敏度高,因而值得在临床推广及应用。Objective To evaluate the effect and value expression of amplitude integrated electroencephalography(aEEG)combined with neonatal behavioral neurological assessment(NBNA)in the diagnosis of brain injury of premature infants(BIPI).Methods From January 2017 to December 2018,218 cases of premature infants(gestational age was 28 to 36 weeks)in our hospital were divided into brain injury group(102 cases)and non brain injury group(116 cases)according to the presence of brain damage factors.Within 6 hours after premature birth,aEEG was recorded in continuous 3 hours;head B ultrasonic examination was performed within 24 hours and on the third day after birth;head Magnetic Resonance Imaging(MRI)detection was performed before leaving the hospital.In addition,NBNA score was performed until 40 weeks of gestational age.According to the characteristics of aEEG and NBNA score,the value of combined two methods in the diagnosis of brain injury in premature infants was evaluated.Results Clinical application showed that the sensitivity of aEEG combined with NBNA in the diagnosis of brain injury of premature infants was 91.87%,which was higher than 86.31% of aEEG and 76.32% of NBNA;the specificity of aEEG combined with NBNA was 67.53%,which was lower than 75.42% of aEEG and 86.37% of NBNA;the area under the ROC curve of combined diagnosis was 0.856,which was higher than 0.813 of aEEG and 0.754 of NBNA.Conclusion The combined evaluation method has a larger area under the ROC curve and higher sensitivity than single evaluation method,is worthy of clinical promotion and application.

关 键 词：振幅整合脑电图 新生儿行为神经测定 早产儿 脑损伤 

分 类 号：R72[医药卫生—儿科]