新生儿惊厥不良结局危险因素分析  

Clinical analysis of risk factors for adverse outcomes of neonatal seizure

作　　者：张彦华[1] 邢景月 华敏敏[1] 夏磊[1] 徐发林[1] Zhang Yanhua;Xing Jingyue;Hua Minmin;Xia Lei;Xu Falin(Department of Neonatology,Third Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第三附属医院新生儿科,郑州450052

出　　处：《中华新生儿科杂志（中英文）》2023年第4期210-214,共5页Chinese Journal of Neonatology

摘　　要：目的探讨新生儿惊厥患儿神经系统预后及不良结局的危险因素。方法选择2019年12月至2020年11月郑州大学第三附属医院新生儿病房收治的新生儿惊厥患儿进行回顾性研究,根据患儿生存结局、12月龄时智力发育指数(mental development index,MDI)、精神运动发育指数(psychomotor development index,PDI)及惊厥发作情况,将患儿分为不良结局组和正常结局组,分析不良结局的危险因素。结果共纳入75例患儿,不良结局组39例,正常结局组36例;振幅整合脑电图(amplitude-integrated electroencephalogram,aEEG)异常69例,其中轻度异常38例、中度异常23例、重度异常8例,不同aEEG异常程度患儿不良结局发生率及死亡率比较,差异均有统计学意义(P<0.05),aEEG异常程度与不良结局发生率和死亡率均成正相关(r=0.367、0.471,P<0.05)。单因素分析显示,不良结局组患儿绒毛膜羊膜炎、发病日龄≤3 d、5 min Apgar评分≤3分、头颅超声异常、头颅MRI异常及aEEG异常发生率均高于正常结局组,差异有统计学意义(P<0.05);logistic回归分析显示,发病日龄≤3 d(OR=3.988,95%CI 1.376~11.674)、头颅MRI异常(OR=3.296,95%CI 2.383~17.377)及胆红素脑病(OR=3.792,95%CI 2.110~13.216)是新生儿惊厥不良结局的独立危险因素(P<0.05)。结论新生儿惊厥患儿aEEG异常程度越重,不良结局发生率及死亡率越高。发病日龄≤3 d、头颅MRI异常及胆红素脑病是新生儿惊厥患儿不良结局的独立危险因素。Objective To study the neurodevelopmental prognosis and risk factors for adverse outcomes of neonatal seizure.Methods From December 2019 to November 2020,infants with neonatal seizure diagnosed in our hospital were enrolled in this retrospective study.Based on survival or not,mental development index(MDI),psychomotor development index(PDI)and seizure episodes at the age of 12 months,the infants were assigned into adverse outcome group and normal outcome group.The risk factors for adverse outcomes were statistically analyzed.Results A total of 75 infants were enrolled,including 39 cases in adverse outcome group and 36 in normal outcome group.69 cases showed abnormal amplitude-integrated electroencephalogram(aEEG),including 38 mildly abnormal cases,23 moderately abnormal cases and 8 severely abnormal cases,The incidences of adverse outcomes and mortality rates were significantly different(P<0.05)among infants with different severity levels of aEEG abnormalities and the severity levels of aEEG abnormalities were positively correlated with adverse outcomes(r=0.367,0.471,P<0.05).Univariate analysis showed that adverse outcome group had significantly higher incidences of chorioamnionitis,seizure onset age≤3 d,5 min Apgar score≤3,cranial ultrasound abnormalities,brain MR abnormalities and aEEG abnormalities than normal outcome group(P<0.05).Logistic regression analysis showed that seizure onset age≤3 d(OR=3.988,95%CI 1.376-11.674),abnormal brain MR(OR=3.296,95%CI 2.383-17.377)and bilirubin encephalopathy(OR=3.792,95%CI 2.110-13.216)were independent risk factors for adverse outcomes of neonatal seizure.Conclusions For neonatal seizure,the infants with more severe abnormal aEEG will have higher incidences of adverse outcomes and mortality.Seizure onset age≤3 d,brain MR abnormalities and bilirubin encephalopathy were independent risk factors for adverse outcomes of neonatal seizure.

关 键 词：新生儿惊厥 振幅整合脑电图 不良结局 危险因素 

分 类 号：R720.597[医药卫生—急诊医学]