持续脑功能监测在HIE早期诊断及预测预后中的价值  

The value of continuous brain function monitoring in the early diagnosis and prediction of prognosis in HIE

作　　者：李萌芽 赵淑华 杨红玲 刘瑞来 吴颖丽 李絮芳 吴娟娟 LI Mengya;ZHAO Shuhua;YANG Hongling;LIU Ruilai;WU Yingli;LI Xufang;WU Juanjuan(School of Clinical Medicine,Dali University,Dali,Yunnan 671000,China;Department of Paediatrics,the First Affiliated Hospital of Dali University and Clinical Medical Sub-centre for Paediatric Diseases of Yunnan Province,Dali,Yunnan 671000,China)

机构地区：[1]大理大学临床医学院,云南大理671000 [2]大理大学第一附属医院儿科暨云南省儿科疾病临床医学分中心,云南大理671000

出　　处：《中国优生与遗传杂志》2023年第12期2583-2586,共4页Chinese Journal of Birth Health & Heredity

基　　金：云南省科技厅地方本科高校基础研究联合专项(202001BA070001-079)。

摘　　要：目的探讨大理高原地区持续脑功能监测在新生儿缺氧缺血性脑病(HIE)早期诊断及预测预后中的价值。方法选择大理大学第一附属医院2020年12月至2022年12月出生6h以内入院,临床诊断为HIE的84例HIE患儿为研究对象,依据HIE临床分度标准分为轻、中、重度3组,在生后1 h内行动脉血气分析,6 h内行振幅整合脑电图(aEEG)检测,持续监测2~4 h,依据aEEG分类结果分为正常、轻度异常、重度异常3组,在生后3~7 d行头颅磁共振(MRI)检查,4月龄时进行《0~6岁儿童发育行为评估量表》评估,分析HIE临床分度与aEEG分类结果的相关性,以及Apgar评分、血气分析、头颅MRI及发育商与aEEG分类之间的相关性。结果HIE临床分度与aEEG分类结果、aEEG分类结果与头颅MRI存在显著相关性,相关性分别为:等级相关系数r=0.527,P<0.001;r=0.567,P<0.001;不同aEEG分类结果患儿在不同时间的Apgar评分有明显统计学差异(P<0.001);生后1 h内pH、碱剩余(BE)与aEEG分类结果差异有统计学意义(P<0.05);不同aEEG分类结果患儿在4月龄时的发育商有明显统计学差异(P<0.001)。结论在大理高原地区持续脑功能监测能早期诊断HIE及判断HIE病情轻重程度,并能预测HIE预后,aEEG异常程度与神经发育预后密切相关。Objective To explore the value of continuous brain function monitoring in early diagnosis and prediction of prognosis of neonatal hypoxic-ischemic encephalopathy(HIE)in the Dali Plateau area.Methods A total of 84 children with HIE who were admitted to the First Affiliated Hospital of Dali University within 6 hours after birth from December 2020 to December 2022 and were clinically diagnosed as HIE were selected as the research objects.According to the clinical grading standard of HIE,they were divided into three groups:Mild,moderate and severe.Arterial blood gas analysis was performed within 1 hour after birth,and amplitude integrated electroencephalogram(aEEG)was performed within 6 hours.Continuous monitoring was performed for 2–4 hours.According to the classification results of aEEG,they were divided into three groups:Normal,mild abnormal and severe abnormal.Head MRI examination was performed 3-7 days after birth.At the age of 4months,the“0–6 years old children's developmental behavior assessment scale”(hereinafter referred to as the child heart scale-II)was evaluated,and the correlation between the clinical grading of HIE and the results of aEEG classification was analyzed,as well as the correlation between Apgar score,blood gas analysis,cranial magnetic resonance imaging(MRI)and developmental quotient and aEEG classification.Results There was a significant correlation between the clinical grading of HIE and the results of aEEG classification,and between aEEG classification results and cranial MRI,the correlation was:Rank correlation coefficient r=0.527,P<0.001;r=0.567,P<0.001.There was a statistically significant difference in Apgar scores between children with different aEEG classification results at different times(P<0.001).There were significant differences in pH,base excess(BE)and aEEG classification results within 1h after birth(P<0.05).There was a statistically significant difference in the developmental quotient of children with different aEEG classification results at 4 months of age(P<0.001).

关 键 词：振幅整合脑电图 早期诊断 缺氧缺血性脑病 新生儿 预后 

分 类 号：R722.1[医药卫生—儿科]