中华围产医学杂志
中華圍產醫學雜誌
중화위산의학잡지
CHINESE JOURNAL OF PERINATAL MEDICINE
2010年
4期
307-313
,共7页
邱甜%邱鹏玲%陈天兰%孙道开%陈超%王艺
邱甜%邱鵬玲%陳天蘭%孫道開%陳超%王藝
구첨%구붕령%진천란%손도개%진초%왕예
窒息,新生儿%脑电描记术%缺氧缺血,脑%敏感性与特异性
窒息,新生兒%腦電描記術%缺氧缺血,腦%敏感性與特異性
질식,신생인%뇌전묘기술%결양결혈,뇌%민감성여특이성
Asphyxia neonatorum%Electroencephalography%Hypoxia-ischemia,brain%Sensitivity and specificity
目的 探讨新生儿生后6 h床旁视频脑电图(video electroencephalogram,VEEG)对缺氧缺血性脑病(hypoxic-ischemic encephalopathy,HIE)的诊断价值以及与早期神经行为发育结局的相关性.方法 采用前瞻性研究方法,连续纳入2009年3月至9月间我院收治的重度窒息新生儿,记录生后6 h床旁VEEG并分度;以HIE标准诊断方案作为临床诊断HIE和分度的金标准.分析生后6 h不同程度VEEG预测相应程度HIE的敏感性和特异性;在观察者盲法的基础上,比较生后6 h、3和7 d异常VEEG预测HIE的敏感性和特异性.生后7～14 d行新生儿行为神经评分(neonatal behavior neurological assessment,NBNA),出院后3月龄门诊随访行脑电图(electroencephalogram,EEG)、全身运动(general movements,GMs)质量评估和0～6岁发育筛查测验(developmental screening test for child under six,DST)评估;6月龄行EEG、贝利婴幼儿发展量表(Bayley scales of infant development,BSID)评估,分析6 h VEEG与近期神经发育结局的相关性.结果 重度窒息新生儿48例纳入分析.诊断为单纯重度窒息12例;HIE 36例,其中轻、中和重度分别为14、12和10例.生后6 h VEEG正常9例;异常39例(81.3%),其中轻、中、重和极重度异常分别为16、11、5和7例.36例HIE新生儿生后6 h VEEG异常32例.异常率88.9%.生后6 h VEEG异常程度与脑损伤程度的等级相关系数为0.849,P<0.01,生后6 h VEEG重度与极重度异常预测重度HIE敏感性为100%,特异性94.7%;生后6 h、3和7 d VEEG预测HIE的敏感性分别为88.9%、83.9%和28.6%,特异性分别为41.7%、91.7%和100.0%.生后6 h VEEG异常并持续异常于院内死亡9例,生后6 h VEEG中、重度异常者NBNA评分显著低于VEEG正常患儿(P均<0.01);VEEG重度异常者NBNA评分显著低于中度异常患儿(P<0.05).3月龄时35例患儿来院随访,32例DST>85分,3例DST 70～84分且伴有EEG异常,其中1例GMs质量评估示不安运动缺乏,提示脑性瘫痪可能性大.6月龄时14例患儿来院随访,7例EEG异常,4例BSID异常且均伴有EEG异常.结论 生后6 h VEEG预测HIE及其严重程度的敏感性和特异性较高,与早期神经发育结局有较好的相关性.
目的 探討新生兒生後6 h床徬視頻腦電圖(video electroencephalogram,VEEG)對缺氧缺血性腦病(hypoxic-ischemic encephalopathy,HIE)的診斷價值以及與早期神經行為髮育結跼的相關性.方法 採用前瞻性研究方法,連續納入2009年3月至9月間我院收治的重度窒息新生兒,記錄生後6 h床徬VEEG併分度;以HIE標準診斷方案作為臨床診斷HIE和分度的金標準.分析生後6 h不同程度VEEG預測相應程度HIE的敏感性和特異性;在觀察者盲法的基礎上,比較生後6 h、3和7 d異常VEEG預測HIE的敏感性和特異性.生後7～14 d行新生兒行為神經評分(neonatal behavior neurological assessment,NBNA),齣院後3月齡門診隨訪行腦電圖(electroencephalogram,EEG)、全身運動(general movements,GMs)質量評估和0～6歲髮育篩查測驗(developmental screening test for child under six,DST)評估;6月齡行EEG、貝利嬰幼兒髮展量錶(Bayley scales of infant development,BSID)評估,分析6 h VEEG與近期神經髮育結跼的相關性.結果 重度窒息新生兒48例納入分析.診斷為單純重度窒息12例;HIE 36例,其中輕、中和重度分彆為14、12和10例.生後6 h VEEG正常9例;異常39例(81.3%),其中輕、中、重和極重度異常分彆為16、11、5和7例.36例HIE新生兒生後6 h VEEG異常32例.異常率88.9%.生後6 h VEEG異常程度與腦損傷程度的等級相關繫數為0.849,P<0.01,生後6 h VEEG重度與極重度異常預測重度HIE敏感性為100%,特異性94.7%;生後6 h、3和7 d VEEG預測HIE的敏感性分彆為88.9%、83.9%和28.6%,特異性分彆為41.7%、91.7%和100.0%.生後6 h VEEG異常併持續異常于院內死亡9例,生後6 h VEEG中、重度異常者NBNA評分顯著低于VEEG正常患兒(P均<0.01);VEEG重度異常者NBNA評分顯著低于中度異常患兒(P<0.05).3月齡時35例患兒來院隨訪,32例DST>85分,3例DST 70～84分且伴有EEG異常,其中1例GMs質量評估示不安運動缺乏,提示腦性癱瘓可能性大.6月齡時14例患兒來院隨訪,7例EEG異常,4例BSID異常且均伴有EEG異常.結論 生後6 h VEEG預測HIE及其嚴重程度的敏感性和特異性較高,與早期神經髮育結跼有較好的相關性.
목적 탐토신생인생후6 h상방시빈뇌전도(video electroencephalogram,VEEG)대결양결혈성뇌병(hypoxic-ischemic encephalopathy,HIE)적진단개치이급여조기신경행위발육결국적상관성.방법 채용전첨성연구방법,련속납입2009년3월지9월간아원수치적중도질식신생인,기록생후6 h상방VEEG병분도;이HIE표준진단방안작위림상진단HIE화분도적금표준.분석생후6 h불동정도VEEG예측상응정도HIE적민감성화특이성;재관찰자맹법적기출상,비교생후6 h、3화7 d이상VEEG예측HIE적민감성화특이성.생후7～14 d행신생인행위신경평분(neonatal behavior neurological assessment,NBNA),출원후3월령문진수방행뇌전도(electroencephalogram,EEG)、전신운동(general movements,GMs)질량평고화0～6세발육사사측험(developmental screening test for child under six,DST)평고;6월령행EEG、패리영유인발전량표(Bayley scales of infant development,BSID)평고,분석6 h VEEG여근기신경발육결국적상관성.결과 중도질식신생인48례납입분석.진단위단순중도질식12례;HIE 36례,기중경、중화중도분별위14、12화10례.생후6 h VEEG정상9례;이상39례(81.3%),기중경、중、중화겁중도이상분별위16、11、5화7례.36례HIE신생인생후6 h VEEG이상32례.이상솔88.9%.생후6 h VEEG이상정도여뇌손상정도적등급상관계수위0.849,P<0.01,생후6 h VEEG중도여겁중도이상예측중도HIE민감성위100%,특이성94.7%;생후6 h、3화7 d VEEG예측HIE적민감성분별위88.9%、83.9%화28.6%,특이성분별위41.7%、91.7%화100.0%.생후6 h VEEG이상병지속이상우원내사망9례,생후6 h VEEG중、중도이상자NBNA평분현저저우VEEG정상환인(P균<0.01);VEEG중도이상자NBNA평분현저저우중도이상환인(P<0.05).3월령시35례환인래원수방,32례DST>85분,3례DST 70～84분차반유EEG이상,기중1례GMs질량평고시불안운동결핍,제시뇌성탄탄가능성대.6월령시14례환인래원수방,7례EEG이상,4례BSID이상차균반유EEG이상.결론 생후6 h VEEG예측HIE급기엄중정도적민감성화특이성교고,여조기신경발육결국유교호적상관성.
Objective To evaluate the diagnostic value of bedside video electroencephalogram (VEEG) in neonatal within 6 h after birth in diagnosing hypoxic-ischemic encephalopathy ( HIE) and the correlation of bedside VEEG results and early neural and behavioral development. Methods Neonatal severe asphyxia cases were collected and bedside VEEG and HIE were recorded and graduated. The sensitivity and specificity of different VEEG degrees within 6 h after birth were calculated in prognosing HIE degree. The sensitivity and specificity of abnormal VEEG performed within 6 h, the third day and the seventh day after birth, respectively, were compared in prognosing HIE. Neonatal behavior neurological assessment (NBNA) was performed at 7 to 14 days of age, EEG and general movements assessment (GMs), developmental screening test for child under six(DST) when patients were 3 months old, and EEG, Bayley scales of infant development(BSID) at 6 months old to analyze the correlation of bedside VEEG results and early neural and behavioral development. Results Forty-eight severe asphyxia neonatal were included, among which 12 severe asphyxia and 36 HIE, including 14 mild, 12 moderate and 10 severe HIE. There were nine normal and 39(81. 3%) abnormal VEEG including 16 mild, 11 moderate, five severe abnormal and seven inactive VEEG within 6 h after birth. There were 32(88. 9%) abnormal VEEG within 6 h after birth in 36 HIE patients. Significant positive correlation was found between VEEG within 6 h after birth and HIE (r= 0.849, P<0. 01). Severe abnormal and inactive EEG within 6 h after birth showed sensitivity of 100%, specificity of 94. 7% in predicting severe HIE. The sensitivity of VEEG testing at 6 h,3 and 7 d in predicting HIE were 88. 9%, 83. 9% and 28. 6% , correspondingly the specificity were 41.7%, 91. 7% and 100%, respectively. Nine patients with continually abnormal VEEG died in hospital. The NBNA scores of patients with moderate and severe abnormal EEG were significantly lower than those with normal EEG (both P<0. 01), the NBNA scores of patients with severe abnormal EEG were significantly lower than those with moderate abnormal EEG (P<0. 05). Thirty-five patients were followed up in the hospital at 3 months old, and 32 patients had DST >85 and three had DST between 70 and 84 with abnormal EEG. GMs assessment of one of the three patients showed absence of fidget movements, cuing a chance of cerebral palsy. Fourteen patients were followed up in hospital at 6 months old, and seven of them had abnormal EEG, four had abnormal BSID with abnormal EEG. Conclusions VEEG within 6 h after birth shows high sensitivity and specificity in prognosing HIE, and much relates to short-term neural and behavior development.
