振幅整合脑电图对新生儿细菌性脑膜炎神经学预后的预测价值  

Predictive value of amplitude integrated electroencephalography in neurological prognosis of neonatal bacterial meningitis

作　　者：周君 赵晓芬[1] 杜琨[1] 刘玲[1] 奚敏[1] 高瑾[1] 朱双燕 张焱[1] 张琳 李杨方[1] 周文浩[3] Zhou Jun;Zhou Xiaofen;Du Kun;Liu Ling;Xi Min;Gao Jin;Zhu Shuangyan;Zhang Yan;Zhang Lin;Li Yangfang;Zhou Wenhao(Department of Neonatology,Kunming Chilren′s Hospital,Kunming 650028,China;Department of Radiology,Kunming Chilren′s Hospital,Kunming 650028,China;Department of Neonatology,Chilren′s Hospital of Fudan University,Shanghai 201102,China)

机构地区：[1]昆明市儿童医院新生儿科,650028 [2]昆明市儿童医院放射科,650028 [3]复旦大学附属儿科医院,上海201102

出　　处：《中国小儿急救医学》2022年第11期875-879,共5页Chinese Pediatric Emergency Medicine

基　　金：国家自然科学基金项目(82060291)。

摘　　要：目的探讨振幅整合脑电图(aEEG)对新生儿细菌性脑膜炎(NBM)患儿神经学预后的预测价值。方法回顾性分析2018年1月至2019年12月在昆明市儿童医院新生儿科住院确诊为NBM并完成aEEG检查的148例患儿的临床资料及aEEG结果。按EEG是否异常分为aEEG异常组及aEEG无异常组,又根据aEEG异常程度,将aEEG异常患儿分为aEEG轻度异常组和aEEG重度异常组。统计aEEG的异常率及异常特征;对两组患儿的临床资料进行分析对比。结果(1)148例NBM患儿aEEG异常49例,无异常99例,aEEG异常率33.1%,aEEG异常依次表现为睡眠觉醒周期成熟延迟39例(26.3%),异常放电8例(5.4%),背景活动异常1例(0.6%)。(2)aEEG异常组患儿惊厥发作、分型为难治性NBM的比例明显多于aEEG无异常组(P<0.05);在脑脊液常规及生化异常指标中,蛋白>3g/L、脑脊液白细胞>500×10^(6)/L、脑脊液糖<1.5 mmol/L、脑脊液培养阳性、血及脑脊液病原学均阳性、头颅MRI异常的比例,aEEG异常组均明显增高(P<0.05);两组血常规白细胞异常、C-反应蛋白升高、血培养阳性比例差异无统计学意义(P>0.05)。(3)对148例NBM患儿随访至15月龄,完成随访119例(80.4%),失访率19.6%;3例死亡,11例有精神运动发育迟缓;aEEG异常与无异常患儿相比,预后有明显差异,Spearman秩相关系数r=0.315(P<0.05)。采用COX回归分析各个指标对不良结局事件的预测价值,aEEG异常为NBM患儿不良结局的独立危险因素(OR=7.452,95%CI 1.605-34.591,P<0.05)。结论对NBM患儿进行aEEG监测,如为异常可提示NBM严重,转变为难治性NBM或预后不良可能性大。Objective To explore the predictive value of amplitude integrated electroencephalography(aEEG)in the neurological prognosis of children with neonatal bacterial meningitis(NBM).Methods The clinical data and aEEG results from 148 children diagnosed with NBM who completed aEEG examinations in the Department of Neonatology at Kunming Children′s Hospital from January 2018 to December 2019 were retrospectively analyzed.According to whether aEEG is abnormal,the children were divided into aEEG abnormal group and aEEG non-abnormal group.According to the degree of aEEG abnormality,children with aEEG abnormality were divided into aEEG mild abnormal group and aEEG severe abnormal group.The abnormal rate and abnormal characteristics of aEEG were analyzed;The clinical data of two groups were compared.Results(1)Among the 148 children with NBM,49 children had abnormal aEEG,99 children had no abnormality,and the aEEG abnormal rate was 33.1%.The abnormal aEEG was manifested as delayed sleep-wake cycle maturation in 39(26.3%)cases,abnormal discharge in eight(5.4%)cases,and abnormal background activity in one(0.6%)case.(2)The proportion of children with convulsive seizures and refractory NBM in aEEG abnormal group were significantly higher than those in aEEG non-abnormal group(P<0.05).In the routine and biochemical abnormal indexes of cerebrospinal fluid,the proportion of protein>3 g/L,cerebrospinal fluid leukocyte>500×10^(6)/L,cerebrospinal fluid glucose<1.5 mmol/L,positive cerebrospinal fluid culture,positive blood and cerebrospinal fluid culture,abnormal head MRI in aEEG abnormal group significantly increased(P<0.05);While there was no significant difference regarding blood routine leukocyte abnormality,CRP increase,and positive blood culture ratio between two groups(P>0.05).(3)148 cases of NBM children were followed up to 15 months old,119(80.4%)cases completed the follow-up,the loss rate was 19.6%,three cases died,and 11 cases had psychomotor retardation.Compared with the children with abnormal aEEG,the prognosis of children

关 键 词：振幅整合脑电图监测 新生儿 细菌性脑膜炎 预后 

分 类 号：R722.1[医药卫生—儿科]