CAJ | 학술논문

目的探讨振幅整合脑电图(aEEG)在新生儿重症监护病房(NICU)内常见的神经系统高风险患儿急性期的改变以及其与疾病预后的相关性.方法 NICU收治42例危重患儿纳入研究,其中低血糖脑损伤10例、急性细菌性脑膜炎15例、急性胆红素脑病10例、遗传代谢性疾病脑损伤7例.记录患儿的临床资料和治疗转归；采用aEEG进行脑功能监测；采用infanib量表进行患儿生后6月龄运动评估；分析aEEG背景活动,癫(癎)性电活动,睡眠觉醒周期(sleep-weak cycle,SwC)等参数以及脑功能监测的综合评分(包括上述三方面参数赋值后所得分数之和)与患儿临床预后的相关性.结果 42例患儿急性期aEEG结果:连续正常电压(continuous normal voltage,CNV)15例,不连续电压(discontinuous voltage,DC)9例,爆发抑制(burst-suppression,BS)13例[其中BS(+)6例、BS(-)7例],平台(flat,Fr)5例；成熟睡眠觉醒周期(sleep-wake cycling,SWC)4例,不成熟SWC 14例,无SWC 24例；30例(71.4％)患儿记录到癫癎性电活动:单次惊厥6例,反复惊厥7例,惊厥持续状态(status epilepticus,SE) 17例.20例预后不良(包括死亡或是随访至生后6月龄infanib评分异常者)FT5例,BS(-)/SE 6例,BS(-)/反复惊厥1例,BS(+)/SE 1例,BS(+)/反复惊厥1例,DC/SE 6例.双向有序等级资料相关性分析提示aEEG背景活动、SWC分类以及脑功能监测的综合评分与患儿临床预后存在相关性.结论 aEEG可以作为NICU内神经系统高风险高患儿的脑功能监测的有用工具,用于评估危重患儿的脑功能严重程度及近期预后.
목적 탐토진폭정합뇌전도(aEEG)재신생인중증감호병방(NICU)내상견적신경계통고풍험환인급성기적개변이급기여질병예후적상관성.방법 NICU수치42례위중환인납입연구,기중저혈당뇌손상10례、급성세균성뇌막염15례、급성담홍소뇌병10례、유전대사성질병뇌손상7례.기록환인적림상자료화치료전귀；채용aEEG진행뇌공능감측；채용infanib량표진행환인생후6월령운동평고；분석aEEG배경활동,전(간)성전활동,수면각성주기(sleep-weak cycle,SwC)등삼수이급뇌공능감측적종합평분(포괄상술삼방면삼수부치후소득분수지화)여환인림상예후적상관성.결과 42례환인급성기aEEG결과:련속정상전압(continuous normal voltage,CNV)15례,불련속전압(discontinuous voltage,DC)9례,폭발억제(burst-suppression,BS)13례[기중BS(+)6례、BS(-)7례],평태(flat,Fr)5례；성숙수면각성주기(sleep-wake cycling,SWC)4례,불성숙SWC 14례,무SWC 24례；30례(71.4％)환인기록도전간성전활동:단차량궐6례,반복량궐7례,량궐지속상태(status epilepticus,SE) 17례.20례예후불량(포괄사망혹시수방지생후6월령infanib평분이상자)FT5례,BS(-)/SE 6례,BS(-)/반복량궐1례,BS(+)/SE 1례,BS(+)/반복량궐1례,DC/SE 6례.쌍향유서등급자료상관성분석제시aEEG배경활동、SWC분류이급뇌공능감측적종합평분여환인림상예후존재상관성.결론 aEEG가이작위NICU내신경계통고풍험고환인적뇌공능감측적유용공구,용우평고위중환인적뇌공능엄중정도급근기예후.
Objective To assess the diagnostic value of amplitude-integrated electroencephalography (aEEG) in predicting outcome of newborns who were at high risk for central nervous system without severe hypoxic-ischemic encephalopathy.Methods Forty-two consecutive patients at risks for neurological disorders referred to our level-Ⅲ NICU were prospectively enrolled in the study over a period of 3 years.They were classified on the basis of their primary diagnoses including hypoglycemic brain damage,meningoencephalitis,bilirubin encephalopathy,and metabolic disease.Clinical data were collected.Amplitude-integrated and raw EEG tracings were assessed for background pattern,sleep-wake cycling,and epileptiform activity.The neuromotor development of survivors was assessed by using the Infant Neurological International Battery (INFANIB).Result The characteristic of aEEG tracings in 42 infants showed continuous normal voltage (CNV) (n =15),discontinuous voltage (DC) (n =9),burst-suppression (BS) BS(+) (n =6),BS(-) (n =7),flat (FT,n =5) ; mature sleep-wake cycling (SWC,n =4),immature SWC (n =14),no SWC (n =24) ; 30 infants (71.4％) had electrical seizures:single seizure (n =6); repetitive seizures (n =7),and status epilepticus (SE) (n =17).aEEG of 20 infants who had poor outcome showed FT (n =5),BS(-)/SE (n =6),BS(-)/repetitive seizures (n =1),BS(+)/SE (n =1),BS(+)/repetitive seizures (n =1),DC/SE(n =6).Chi-square analysis and Spearman rank correlation analysis showed the classification of aEEG background pattern,SWC and comprehensive score (score system was developed by evaluation of the above 3 variables) were correlated with the outcome of these infants at high neurological risks.Conclusion Amplitude-integrated electroencephalography can provide important information of the status of cerebral function in neonates at high neurological risk and help to predict their outcome.