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中国循证儿科杂志

中国循证儿科杂志 ›› 2010, Vol. 5 ›› Issue (2): 116-121.DOI:

• 论著 • 上一篇    下一篇

两种脑电图背景分级标准对重度窒息新生儿神经行为发育预后的比较

邱甜,邱鹏玲,陈天兰,孙道开,陈超,王艺   

  1. 复旦大学附属儿科医院,上海201102
  • 收稿日期:2010-02-25 修回日期:2010-03-08 出版日期:2010-03-10 发布日期:2010-03-10
  • 通讯作者: 王艺

The predictive value of early EEG background in the prognosis of neurodevelopment with neonatal asphyxia

QIU Tian, QIU Peng-lin, CHEN Tian-lan, SUN Dao-kai, CHEN Chao, WANG Yi   

  1. Children′s Hospital of Fudan University, Shanghai 201102, China
  • Received:2010-02-25 Revised:2010-03-08 Online:2010-03-10 Published:2010-03-10
  • Contact: WANG Yi

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摘要：

目的 对足月重度窒息新生儿生后6 h内行VEEG监测，比较不同EEG背景异常分级标准与早期神经行为发育结局的相关性。方法 对收集的足月重度窒息新生儿于生后6 h内行床旁VEEG监测，分别按EEG背景异常分级A（临床脑电图学，人民卫生出版社）和B标准［Pediatrics,2006,118(1)］和发作性异常放电标准，对观察对象的VEEG进行判读。于生后3和7 d行VEEG复查，3和6月龄行EEG复查；7~14 d 行新生儿行为神经评估（NBNA）评分、3月龄行全身运动(GMs)质量评估和0~6岁发育筛查测验(DST)，6月龄行贝利婴幼儿发展量表(BSID)评估，随访神经行为发育结局。分析不同EEG背景异常分级标准与早期神经行为发育结局的相关性。 结果 48例足月重度窒息新生儿进入分析，其中男26例，女22例。9例VEEG无背景异常；39例有背景异常，单纯背景异常组11例、背景异常伴发作性异常放电组28例。①A、B标准单纯背景异常组，轻度异常各3例，中度异常分别为2例和0，重度异常分别为6例和2例，B标准中不活跃EEG 6例。②A、B标准背景异常伴发作性异常放电组：轻度异常分别为21例和13例，中度异常分别为6例和11例，重度异常分别为1例和3例，B标准中不活跃EEG 1例。③3 d VEEG异常27/43例，7 d VEEG异常8/40例，3月龄EEG异常10/35例，6月龄EEG异常7/10例；④死亡9例；7~14 d NBNA评分异常20/39例；3月龄GMs异常1/35例，DST异常3/35例；6月龄神经行为发育异常患儿4例，BSID和EEG均异常，考虑精神运动发育迟缓或脑性瘫痪。⑤轻度背景异常：按A标准，1/24例6月龄神经行为发育结局预后不良（死亡或神经行为发育异常）；按B标准，0/16例神经行为发育结局预后不良；中度背景异常：A标准神经行为发育结局预后不良发生率高于B标准（5/8例 vs 3/11例）；重度背景异常：按A标准，7/7例神经行为发育结局预后不良；按B标准（包括不活跃EEG），10/12例神经行为发育结局预后不良；A和B标准对预后不良结局的差异均无统计学意义。结论 轻、重度背景异常EEG与早期神经行为发育预后的相关性较好。背景爆发间隔时间与低电压水平的量化标准，是不同EEG分级标准中度背景异常重度窒息新生儿预后结局不一致的原因之一。EEG背景异常分级A标准较B标准更接近于预后结局。

关键词: 视频脑电图, 新生儿窒息, 预后, 足月儿

Abstract:

Objective To compare the predictive value of abnormal EEG background within 6 h after birth by different criteria in the prognosis of neurodevelopment of patients with neonatal asphyxia. Methods According to the recent neonatal EEG criteria of Liu published in Clinical EEG 2008 (criteria A) and Murray's criteria (criteria B, published in Pediatrics 2006), we analyzed the VEEG including the EEG background and seizure discharges in the newborns with severe asphyxia. In order to follow up the neurodevelopment outcomes, we used NBNA during 7-14 d after birth, GMs and DST at 3 months of age, BSID at 6 months of age. VEEG were recorded at 6 h, 3 d, 7d after birth. And we followed up the patient's EEG at 3 months and 6 months of age. Results 48 severe asphyxia newborns were collected in this study (26 males and 22 females). The VEEG were normal in 9 cases and in 39 were abnormal, in which there were 11 cases with abnormal EEG background and 28 cases with abnormal EEG background and paradoxical discharges. According to criteria A, there were 24 cases with mild abnormal EEG, 8 moderate and 7 severe abnormal EEG. According to criteria B, there were 16 cases with mild abnormal EEG, 11 moderate, 5 severe abnormal EEG and 7 inactive EEG. By following-up EEG, there were 27 of 43 cases with abnormal EEG at 3 d, 8 of 40 cases with abnormal EEG at 7 d, 10 of 35 cases with abnormal EEG at 3 months and 7 of 10 cases with abnormal EEG at 6 months. In 48 patients, there were 9 cases died, 20 of 39 cases with abnormal NBNA scores during 7-14 d, 1 of 35 cases with abnormal GMs at 3 months, 3 of 35 cases with abnormal DST scores at 3 months. There were 4 cases with abnormal BSID scores at 6 months and diagnosed as psychomotor retardation or cerebral palsy. We found no significant difference in the predictive value of mild and severe EEG background between criteria A and B. There were more cases with moderate abnormal EEG having poor neurodevelopment according to criteria A than that according to criteria B (5/8 cases vs 3/11 cases). Conclusions Both criteria A and B have the predictive value in the prognosis of neurodevelopment in the patients with neonatal asphyxia. There were some differences in the moderated abnormal EEG background determined by criteria A and B. Criteria A seemed to be more sensitive than criteria B in the evaluation of neonatal abnormal EEG background and the prediction of the neurodevelopment outcomes.

Key words: Neonatal asphyxia, Prognosis, Term infant, Video electroencephalogram