CAJ | 학술논문

目的探讨双导振幅整合脑电图(amplitude-integrated electroencephalogram,aEEG)(C3-C4/T3-T4)附加对应的双导原始脑电图(electroencephalogram,EEG)诊断新生儿惊厥的价值及局限性. 方法 2011年1月至7月,对66例入住复旦大学附属儿科医院的临床有惊厥发作或可疑惊厥发作的新生儿,进行床旁视频脑电图(video electroencephalogram,VEEG)监测,时间≥3h.通过Galileo NT PMS软件将原始EEG转化为3种形式aEEG,即单导aEEG(C3-C4)、单导aEEG(C3-C4)附加原始EEG、双导aEEG(C3-C4/T3-T4)附加原始EEG.EEG和aEEG分开判读,VEEG需标记电发作(≥10 s)起始放电灶及放电持续时间,aEEG只进行电发作标记.以VEEG作为标准,采用Spearman相关分析计算aEEG与VEEG识别电发作的相关性.以敏感性、特异性、阳性预测值、阴性预测值评估aEEG诊断新生儿惊厥的价值及局限性. 结果共62例新生儿的脑电图纳入分析.(1)电发作:VEEG发现39例患儿电发作≥1次,其中8例发生癫痫持续状态,31例非癫痫持续状态惊厥.31例非癫痫持续状态惊厥VEEG发现电发作活动累计352次,其中79.3％(279次)以颞中央区为起始放电灶.(2)电发作次数识别敏感性:8例癫痫持续状态,aEEG与VEEG诊断结果一致；VEEG监测到352次非癫痫持续状态电发作,单导aEEG、单导aEEG附加原始EEG和双导aEEG附加原始EEG识别电发作敏感性分别为49.1％(173/352)、54.5％ (192/352)和81.2％ (286/352),各组识别电发作数和VEEG记录的放电灶记录总数均相关(ρ=0.790、0.907和0.953,P均＜0.01).(3)惊厥患儿识别敏感性(≥1次电发作):单导aEEG、单导aEEG附加原始EEG和双导aEEG附加原始EEG识别惊厥患儿的敏感性分别为66.7％ (26/39,95％ CI:0.62～0.81)、74.4％ (29/39,95％CI:0.78～0.96)和89.7％ (35/39,95％CI:0.89～1.00). 结论结合VEEG,有助于aEEG诊断新生儿惊厥,aEEG添加T3-T4导联及原始EEG可显著提高其对惊厥电发作及惊厥患儿的识别敏感性. 目的探討雙導振幅整閤腦電圖(amplitude-integrated electroencephalogram,aEEG)(C3-C4/T3-T4)附加對應的雙導原始腦電圖(electroencephalogram,EEG)診斷新生兒驚厥的價值及跼限性. 方法 2011年1月至7月,對66例入住複旦大學附屬兒科醫院的臨床有驚厥髮作或可疑驚厥髮作的新生兒,進行床徬視頻腦電圖(video electroencephalogram,VEEG)鑑測,時間≥3h.通過Galileo NT PMS軟件將原始EEG轉化為3種形式aEEG,即單導aEEG(C3-C4)、單導aEEG(C3-C4)附加原始EEG、雙導aEEG(C3-C4/T3-T4)附加原始EEG.EEG和aEEG分開判讀,VEEG需標記電髮作(≥10 s)起始放電竈及放電持續時間,aEEG隻進行電髮作標記.以VEEG作為標準,採用Spearman相關分析計算aEEG與VEEG識彆電髮作的相關性.以敏感性、特異性、暘性預測值、陰性預測值評估aEEG診斷新生兒驚厥的價值及跼限性. 結果共62例新生兒的腦電圖納入分析.(1)電髮作:VEEG髮現39例患兒電髮作≥1次,其中8例髮生癲癇持續狀態,31例非癲癇持續狀態驚厥.31例非癲癇持續狀態驚厥VEEG髮現電髮作活動纍計352次,其中79.3％(279次)以顳中央區為起始放電竈.(2)電髮作次數識彆敏感性:8例癲癇持續狀態,aEEG與VEEG診斷結果一緻；VEEG鑑測到352次非癲癇持續狀態電髮作,單導aEEG、單導aEEG附加原始EEG和雙導aEEG附加原始EEG識彆電髮作敏感性分彆為49.1％(173/352)、54.5％ (192/352)和81.2％ (286/352),各組識彆電髮作數和VEEG記錄的放電竈記錄總數均相關(ρ=0.790、0.907和0.953,P均＜0.01).(3)驚厥患兒識彆敏感性(≥1次電髮作):單導aEEG、單導aEEG附加原始EEG和雙導aEEG附加原始EEG識彆驚厥患兒的敏感性分彆為66.7％ (26/39,95％ CI:0.62～0.81)、74.4％ (29/39,95％CI:0.78～0.96)和89.7％ (35/39,95％CI:0.89～1.00). 結論結閤VEEG,有助于aEEG診斷新生兒驚厥,aEEG添加T3-T4導聯及原始EEG可顯著提高其對驚厥電髮作及驚厥患兒的識彆敏感性.
목적 탐토쌍도진폭정합뇌전도(amplitude-integrated electroencephalogram,aEEG)(C3-C4/T3-T4)부가대응적쌍도원시뇌전도(electroencephalogram,EEG)진단신생인량궐적개치급국한성. 방법 2011년1월지7월,대66례입주복단대학부속인과의원적림상유량궐발작혹가의량궐발작적신생인,진행상방시빈뇌전도(video electroencephalogram,VEEG)감측,시간≥3h.통과Galileo NT PMS연건장원시EEG전화위3충형식aEEG,즉단도aEEG(C3-C4)、단도aEEG(C3-C4)부가원시EEG、쌍도aEEG(C3-C4/T3-T4)부가원시EEG.EEG화aEEG분개판독,VEEG수표기전발작(≥10 s)기시방전조급방전지속시간,aEEG지진행전발작표기.이VEEG작위표준,채용Spearman상관분석계산aEEG여VEEG식별전발작적상관성.이민감성、특이성、양성예측치、음성예측치평고aEEG진단신생인량궐적개치급국한성. 결과 공62례신생인적뇌전도납입분석.(1)전발작:VEEG발현39례환인전발작≥1차,기중8례발생전간지속상태,31례비전간지속상태량궐.31례비전간지속상태량궐VEEG발현전발작활동루계352차,기중79.3％(279차)이섭중앙구위기시방전조.(2)전발작차수식별민감성:8례전간지속상태,aEEG여VEEG진단결과일치；VEEG감측도352차비전간지속상태전발작,단도aEEG、단도aEEG부가원시EEG화쌍도aEEG부가원시EEG식별전발작민감성분별위49.1％(173/352)、54.5％ (192/352)화81.2％ (286/352),각조식별전발작수화VEEG기록적방전조기록총수균상관(ρ=0.790、0.907화0.953,P균＜0.01).(3)량궐환인식별민감성(≥1차전발작):단도aEEG、단도aEEG부가원시EEG화쌍도aEEG부가원시EEG식별량궐환인적민감성분별위66.7％ (26/39,95％ CI:0.62～0.81)、74.4％ (29/39,95％CI:0.78～0.96)화89.7％ (35/39,95％CI:0.89～1.00). 결론 결합VEEG,유조우aEEG진단신생인량궐,aEEG첨가T3-T4도련급원시EEG가현저제고기대량궐전발작급량궐환인적식별민감성.
Objective To characterize contemporary electrographic neonatal seizures by video electroencephalogram (VEEG) and to assess the value and the limitations of two-channel (C3-C4/T3-T4) amplitude-integrated electroencephalogram (aEEG) plus original EEG signals used to diagnose neonatal seizure with video EEG as a golden standard.Methods Sixty-six neonates admitted to Children's Hospital of Fudan University from January 2011 to July 2011 with clinical or suspected clinical seizure were investigated and bedside VEEG were recorded for more than 3 hours.VEEG signals were transformed into three kinds of aEEG signals by Galileo NT PMS software:one-channel aEEG (C3-C4),one-channel aEEG (C3-C4) plus original EEG,two-channel aEEG (C3-C4/T3-T4) plus original EEG.Electrical seizure activity on VEEG was signed out with respect to its occurrence,duration and localization of seizure onset; while aEEG seizure was recorded only with its occurrence.The relationship between aEEG and VEEG was analyzed by Spearman analysis.The value and the limitations of aEEG to diagnose neonatal seizure were evaluated by sensitivity,specificity,positive predictive value and negative predictive value.Results A total of 62 traces were suitable for analysis.(1) VEEG showed 39 seizure activities,among which 8 status epilepticus; and the rest 31 neonates had 352 non-status epilepticus electrical seizures,79.3％ (279/352) of which occurred over the centrotemporal region.(2) Eight cases with status epilepticus on VEEG were all diagnosed as status epilepticus on aEEG.For non-status epilepticus electrical seizures,the sensitivity of aEEG for detection of electrical seizures was as followed:49.1％ (173/352) for one-channel aEEG,54.5 ％ (192/352) for one-channel aEEG plus original EEG,81.2％ (286/353) for two-channel aEEG plus original EEG.Results from one-channel aEEG,one-channel aEEG plus original EEG and two-channel aEEG plus original EEG were all related to VEEG (ρ =0.790,0.907 and 0.953,respectively,P＜ 0.01).(3) Sensitivity of seizure detection was 66.7％ (26/39,95％ CI:0.62-0.81) for one-channel aEEG,74.4％(29/39,95％ CI:0.78-0.96) for one-channel aEEG(C3-C4) plus original EEG and 89.7％ (35/39,95％ CI:0.89-1.00) for two-channel aEEG(C3-C4/T3-T4) plus original EEG.Conclusions VEEG might help aEEG in diagnosis of neonatal seizure.two-channel aEEG (C3-C4/T3-T4) plus original EEG could significantly increase the sensitivity of neonatal seizures indentification.