CAJ | 학술논문

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. 目的對足月重度窒息新生兒生後6 h內行VEEG鑑測,比較不同EEG揹景異常分級標準與早期神經行為髮育結跼的相關性.方法對收集的足月重度窒息新生兒于生後6 h內行床徬VEEG鑑測,分彆按EEG揹景異常分級A(臨床腦電圖學,人民衛生齣版社)和B標準[Pediatrics,2006,118(1)]和髮作性異常放電標準,對觀察對象的VEEG進行判讀.于生後3和7 d行VEEG複查,3和6月齡行EEG複查;7～14 d 行新生兒行為神經評估(NBNA)評分、3月齡行全身運動(GMs)質量評估和0～6歲髮育篩查測驗(DST),6月齡行貝利嬰幼兒髮展量錶(BSID)評估,隨訪神經行為髮育結跼.分析不同EEG揹景異常分級標準與早期神經行為髮育結跼的相關性.結果 48例足月重度窒息新生兒進入分析,其中男26例,女22例.9例VEEG無揹景異常;39例有揹景異常,單純揹景異常組11例、揹景異常伴髮作性異常放電組28例.①A、B標準單純揹景異常組,輕度異常各3例,中度異常分彆為2例和0,重度異常分彆為6例和2例,B標準中不活躍EEG 6例.②A、B標準揹景異常伴髮作性異常放電組:輕度異常分彆為21例和13例,中度異常分彆為6例和11例,重度異常分彆為1例和3例,B標準中不活躍EEG 1例.③3 d VEEG異常27/43例,7 d VEEG異常8/40例,3月齡EEG異常10/35例,6月齡EEG異常7/10例;④死亡9例;7～14 d NBNA評分異常20/39例;3月齡GMs異常1/35例,DST異常3/35例;6月齡神經行為髮育異常患兒4例,BSID和EEG均異常,攷慮精神運動髮育遲緩或腦性癱瘓.⑤輕度揹景異常:按A標準,1/24例6月齡神經行為髮育結跼預後不良(死亡或神經行為髮育異常);按B標準,0/16例神經行為髮育結跼預後不良;中度揹景異常:A標準神經行為髮育結跼預後不良髮生率高于B標準(5/8例 vs 3/11例);重度揹景異常:按A標準,7/7例神經行為髮育結跼預後不良;按B標準(包括不活躍EEG),10/12例神經行為髮育結跼預後不良;A和B標準對預後不良結跼的差異均無統計學意義.結論輕、重度揹景異常EEG與早期神經行為髮育預後的相關性較好.揹景爆髮間隔時間與低電壓水平的量化標準,是不同EEG分級標準中度揹景異常重度窒息新生兒預後結跼不一緻的原因之一.EEG揹景異常分級A標準較B標準更接近于預後結跼.
목적 대족월중도질식신생인생후6 h내행VEEG감측,비교불동EEG배경이상분급표준여조기신경행위발육결국적상관성.방법 대수집적족월중도질식신생인우생후6 h내행상방VEEG감측,분별안EEG배경이상분급A(림상뇌전도학,인민위생출판사)화B표준[Pediatrics,2006,118(1)]화발작성이상방전표준,대관찰대상적VEEG진행판독.우생후3화7 d행VEEG복사,3화6월령행EEG복사;7～14 d 행신생인행위신경평고(NBNA)평분、3월령행전신운동(GMs)질량평고화0～6세발육사사측험(DST),6월령행패리영유인발전량표(BSID)평고,수방신경행위발육결국.분석불동EEG배경이상분급표준여조기신경행위발육결국적상관성.결과 48례족월중도질식신생인진입분석,기중남26례,녀22례.9례VEEG무배경이상;39례유배경이상,단순배경이상조11례、배경이상반발작성이상방전조28례.①A、B표준단순배경이상조,경도이상각3례,중도이상분별위2례화0,중도이상분별위6례화2례,B표준중불활약EEG 6례.②A、B표준배경이상반발작성이상방전조:경도이상분별위21례화13례,중도이상분별위6례화11례,중도이상분별위1례화3례,B표준중불활약EEG 1례.③3 d VEEG이상27/43례,7 d VEEG이상8/40례,3월령EEG이상10/35례,6월령EEG이상7/10례;④사망9례;7～14 d NBNA평분이상20/39례;3월령GMs이상1/35례,DST이상3/35례;6월령신경행위발육이상환인4례,BSID화EEG균이상,고필정신운동발육지완혹뇌성탄탄.⑤경도배경이상:안A표준,1/24례6월령신경행위발육결국예후불량(사망혹신경행위발육이상);안B표준,0/16례신경행위발육결국예후불량;중도배경이상:A표준신경행위발육결국예후불량발생솔고우B표준(5/8례 vs 3/11례);중도배경이상:안A표준,7/7례신경행위발육결국예후불량;안B표준(포괄불활약EEG),10/12례신경행위발육결국예후불량;A화B표준대예후불량결국적차이균무통계학의의.결론 경、중도배경이상EEG여조기신경행위발육예후적상관성교호.배경폭발간격시간여저전압수평적양화표준,시불동EEG분급표준중도배경이상중도질식신생인예후결국불일치적원인지일.EEG배경이상분급A표준교B표준경접근우예후결국.
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.