低血糖晚期早产儿早期振幅整合脑电图改变的临床意义  

Clinical significance of early amplitude-integrated electroencephalogram changes in late preterm infants with hypoglycemia

作　　者：孙文佳 马丽丽 胡芳 李海燕 岳梦琦 程伟 冯小敏 王国琴 魏巍 张士发 SUN Wenjia;MA Lili;HU Fang;LI Haiyan;YUE Mengqi;CHENG Wei;FENG Xiaomin;WANG Guoqin;WEI Wei;ZHANG Shifa(Department of Pediatrics,The First Affiliated Hospital of Wannan Medical College,Wuhu 241001,China)

机构地区：[1]皖南医学院第一附属医院弋矶山医院儿科,安徽芜湖241001

出　　处：《皖南医学院学报》2023年第4期347-351,共5页Journal of Wannan Medical College

基　　金：弋矶山医院三新项目(Y21006)。

摘　　要：目的:探讨低血糖晚期早产儿早期出现振幅整合脑电图(aEEG)改变的临床意义。方法:选取2021年9月~2022年9月弋矶山医院NICU病区收治的胎龄为34^(+0)~36^(+6)周的低血糖晚期早产儿作为研究对象,随机选取同期住院的血糖正常晚期早产儿作为对照组。低血糖组患儿在发现血糖异常48 h内完成aEEG监测,对照组在出生后72 h内完成aEEG监测,监测时间均不少于4 h,两组晚期早产儿均于纠正胎龄满42周后完成新生儿行为神经测定(NBNA)评分评估神经发育情况。对两组患儿aEEG评分情况进行比较,比较不同aEEG异常程度患儿血糖分布情况及NBNA得分情况,不同NBNA得分晚期早产儿aEEG异常率比较。采用受试者工作特征(ROC)曲线分析aEEG评分对低血糖晚期早产儿神经发育的评估价值。结果:各胎龄段低血糖晚期早产儿aEEG得分在曲线变异度、睡眠觉醒周期、宽带振幅、总分异常率高于对照组(P<0.05)。aEEG异常程度更严重的晚期早产儿全血血糖更低、血糖波动幅度更大、低血糖持续时间更长(P<0.05)。NBNA得分情况比较中,aEEG正常组行为能力、被动肌张力、总分高于aEEG异常组(P<0.05)。ROC曲线分析显示,aEEG评分对低血糖晚期早产儿神经发育具有较高的评估价值,曲线下面积(AUC)为0.873(95%CI:0.751~0.996,P<0.001),截断值为3.5分,灵敏度为77.8%,特异度为98.5%。结论:早期aEEG的监测对预测低血糖晚期早产儿神经发育结局可能有一定的临床价值。Objective:To investigate the clinical significance of early amplitude-integrated electroencephalogram(aEEG)changes in late preterm infants with hypoglycemia.Methods:The study included late preterm infants with hypoglycemia(34^(+0)-36^(+6) weeks gestational age)admitted to neonatal intensive care unit(NICU)of our hospital between September 2021 and September 2022,and randomly enrolled those with normal blood glucose levels hospitalized during the same period as control group.The hypoglycemia group underwent aEEG monitoring within 48 hours after the detection of abnormal blood glucose,while the control group received aEEG monitoring within 72 hours afteRbirth.The monitoring time was no less than 4 hours.Neonatal behavioral neurological assessment(NBNA)was used to evaluate the neurodevelopment of all infants at 42 weeks corrected gestational age.Comparison was made regarding the aEEG scores of two groups,the blood glucose distribution and NBNA scores of infants with different levels of abnormal aEEG,and the aEEG abnormal rates of those with different NBNA scores.Receive roperating characteristic(ROC)curve was used to analyze the value of aEEG score in evaluating the neurodevelopment of late preterm infants with hypoglycemia.Results:The abnormal rates of the hypoglycemia group were significantly higheRthan those of the control group regarding the aEEG scores of curve variability,sleep-wake cycle,broadband amplitude and total score(P<0.05).The late preterm infants with higheRlevel of aEEG abnormality had loweRwhole blood glucose,greater glucose fluctuation and longer duration of hypoglycemia(all P<0.05).Normal aEEG group had significantly higheRscores in behavioral ability,passive muscle tone and total score than abnormal aEEG group(P<0.05).ROC curve analysis showed that aEEG score had a high value foRassessing neurodevelopment in late preterm infants with hypoglycemia,with an area under the curve(AUC)of 0.873(95%CI:0.751-0.996,P<0.001),a cut-off value of 3.5 points,a sensitivity of 77.8%and a specificity of 98.5%.Con

关 键 词：晚期早产儿 低血糖 振幅整合脑电图 新生儿行为神经测定 

分 类 号：R722.6[医药卫生—儿科]