全身运动评估联合脑功能监测在新生儿脑损伤早期诊断中的应用  

Application of general movements assessment combined with brain function monitoring in early diagnosis of neonatal brain injury

作　　者：袁丹[1] 梁玉兰[1] 陈亮[1] 罗晶[1] 李茂 雷小莉 李红梅[1] YUAN Dan;LIANG Yu-lan;CHEN Liang;LUO Jing;LI Mao;LEI Xiao-li;LI Hong-mei(Department of Pediatrics,Luzhou People's Hospital,Luzhou,Sichuan 646000,China)

机构地区：[1]泸州市人民医院儿科,四川泸州646000

出　　处：《中国儿童保健杂志》2020年第7期787-790,共4页Chinese Journal of Child Health Care

基　　金：四川省卫生和计划生育委员会科研课题(16PJ170)。

摘　　要：目的探讨全身运动(GMs)评估联合振幅整合脑电图(aEEG)监测对新生儿脑损伤早期诊断的价值。方法选取2016年8月-2018年1月于泸州市人民医院出生的82例脑损伤高危新生儿作为研究对象,所有受试患儿足月前与足月后2月分别进行2次GMs评估,足月后9~15周再进行1次评估,所有受试患儿出生后6 h内进行aEEG监测,分析GMs、aEEG检测结果及联合检查诊断情况。结果82例新生儿中金标准检测脑瘫3例(3.66%),运动发育迟缓者21例(25.61%),运动发育正常者58例(70.73%)。GMs检测扭动运动阶段异常28例,其中23例单调性GMs(PR)异常,5例痉挛-同步性GMs(CS)异常;不安运动阶段5例异常,其中3例异常均为脑瘫患儿。aEEG检测轻度异常24例,重度异常6例,正常52例,总异常率为36.59%(30/82);GMs、aEEG单独检测预测脑瘫敏感度、阴性预测值为100.00%,而阳性预测值较低,单独预测运动发育迟缓灵敏度、特异性、准确率都在80%以上;二者联合检测预测运动发育迟缓和脑瘫灵敏度、特异性、阳性预测值、阴性预测值及诊断准确度均高于两指标单独检测。结论GMs评估联合aEEG监测预测新生儿脑损伤灵敏度、特异性及准确率高,对新生儿脑损伤具有较高临床预测价值。Objective To explore the value of general movements(GMs)assessment combined with amplitude integrated electroencephalogram(aEEG)monitoring in the early diagnosis of neonatal brain injury.Methods A total of 82 high-risk neonates with brain injury born in Luzhou People's Hospital from August 2016 to January 2018 were enrolled in this study.All children were assessed twice by GMs before full term and 2 months after full term.Another assessment was conducted in 9 to 15 weeks after full-term,and all subjects were monitored for aEEG within 6 hours of birth.The results of GMs and aEEG and the diagnostic value of combined examination were observed.Results Among 82 neonates,3(3.66%)cases were diagnosed with cerebral palsy by the gold standard,21(25.61%)cases had motor retardation,and 58(70.73%)cases had normal motor development.GMs result showed that 28 cases had abnormalities in torsional movement stage,including 23 cases of monotonic GMs(PR)abnormalities and 5 cases of spasmodic-synchronous GMs(CS)abnormalities.There were 5 cases had abnormalities in restless movement stage,of whom 3 cases were with cerebral palsy.Besides,aEEG test indicated that there were 24 mild abnormalities,6 severe abnormalities and 52 normal cases,with the total abnormality rate of 36.59%(30/82).The sensitivity and negative prediction value of GMs and aEEG for predicting cerebral palsy were both 100.00%,but its positive prediction value was low.Moreover,the sensitivity,specificity,and accuracy of predicting motor retardation separately were all higher than 80%.Additionally,the sensitivity,specificity,positive prediction value,negative prediction value,and diagnostic accuracy of the combination of GMs and aEEG were higher than those of single detection method.Conclusion GMs assessment combined with aEEG monitoring has high clinical predictive value for neonatal brain injury because of high sensitivity,specificity,and accuracy.

关 键 词：脑损伤 高危儿 全身运动 振幅整合脑电图 联合检测 

分 类 号：R722.1[医药卫生—儿科]