CAJ | 학술논문

目的：探讨早产儿生后早期脑功能发育特点及其影响因素。方法2009年4月至2013年8月于北京大学第一医院新生儿科就诊的出生胎龄＜37周的早产儿153例，于纠正胎龄足月时（≥38周~＜42周）进行振幅整合脑电图（amplitude-integrated electroencephalography， aEEG）检查。分析早产儿出生胎龄（＜30、30≤~≤33+6和34≤~≤36+6周）、临床情况[相对平稳早产儿组（无任何严重合并症及脑损伤者104例）、仅患严重脑损伤组（19例）和仅患严重全身疾病组（30例）]及营养状况（营养良好或营养不良）对aEEG的影响，以及纠正胎龄足月时头颅B超及纠正胎龄6个月后Gesell量表评价与aEEG结果异常的关系。采用χ2检验、两独立样本t检验及Logistic回归分析进行统计学分析。结果纠正胎龄足月时，52%（79/153）的早产儿aEEG达到正常足月儿水平，其余48%（74/153）aEEG异常。相对平稳早产儿随着胎龄增加，aEEG异常率由＜30周组的3/6逐渐降至34≤~≤36+6周组的35%（13/37），但差异无统计学意义（χ2=1.998， P=0.353）。严重脑损伤组早产儿aEEG结果异常率高于相对平稳早产儿[14/19与44%（46/104），χ2=5.578，P=0.024]。在相对平稳早产儿组，宫内营养不良者的aEEG异常率与营养良好者比较，差异无统计学意义[46%（19/41）与43%（27/63），χ2=0.122，P=0.727]；宫外营养不良者的aEEG异常率与营养良好者比较，差异也无统计学意义[52%（13/25）与42%（33/79），χ2=0.805， P=0.369]。早产儿严重脑损伤是aEEG结果异常的独立危险因素（OR=3.453，95%CI：1.177~10.132， P=0.024）。aEEG检查结果与头颅B超检查结果的符合率为57%（56/98），与Gesell发育量表评估结果符合率为50%（10/20）。结论早产儿生后早期脑功能可能存在追赶性发育，但受到出生胎龄和脑损伤严重程度的影响，结合其他评价方法可共同反映早产儿生后早期神经系统发育情况。目的：探討早產兒生後早期腦功能髮育特點及其影響因素。方法2009年4月至2013年8月于北京大學第一醫院新生兒科就診的齣生胎齡＜37週的早產兒153例，于糾正胎齡足月時（≥38週~＜42週）進行振幅整閤腦電圖（amplitude-integrated electroencephalography， aEEG）檢查。分析早產兒齣生胎齡（＜30、30≤~≤33+6和34≤~≤36+6週）、臨床情況[相對平穩早產兒組（無任何嚴重閤併癥及腦損傷者104例）、僅患嚴重腦損傷組（19例）和僅患嚴重全身疾病組（30例）]及營養狀況（營養良好或營養不良）對aEEG的影響，以及糾正胎齡足月時頭顱B超及糾正胎齡6箇月後Gesell量錶評價與aEEG結果異常的關繫。採用χ2檢驗、兩獨立樣本t檢驗及Logistic迴歸分析進行統計學分析。結果糾正胎齡足月時，52%（79/153）的早產兒aEEG達到正常足月兒水平，其餘48%（74/153）aEEG異常。相對平穩早產兒隨著胎齡增加，aEEG異常率由＜30週組的3/6逐漸降至34≤~≤36+6週組的35%（13/37），但差異無統計學意義（χ2=1.998， P=0.353）。嚴重腦損傷組早產兒aEEG結果異常率高于相對平穩早產兒[14/19與44%（46/104），χ2=5.578，P=0.024]。在相對平穩早產兒組，宮內營養不良者的aEEG異常率與營養良好者比較，差異無統計學意義[46%（19/41）與43%（27/63），χ2=0.122，P=0.727]；宮外營養不良者的aEEG異常率與營養良好者比較，差異也無統計學意義[52%（13/25）與42%（33/79），χ2=0.805， P=0.369]。早產兒嚴重腦損傷是aEEG結果異常的獨立危險因素（OR=3.453，95%CI：1.177~10.132， P=0.024）。aEEG檢查結果與頭顱B超檢查結果的符閤率為57%（56/98），與Gesell髮育量錶評估結果符閤率為50%（10/20）。結論早產兒生後早期腦功能可能存在追趕性髮育，但受到齣生胎齡和腦損傷嚴重程度的影響，結閤其他評價方法可共同反映早產兒生後早期神經繫統髮育情況。
목적：탐토조산인생후조기뇌공능발육특점급기영향인소。방법2009년4월지2013년8월우북경대학제일의원신생인과취진적출생태령＜37주적조산인153례，우규정태령족월시（≥38주~＜42주）진행진폭정합뇌전도（amplitude-integrated electroencephalography， aEEG）검사。분석조산인출생태령（＜30、30≤~≤33+6화34≤~≤36+6주）、림상정황[상대평은조산인조（무임하엄중합병증급뇌손상자104례）、부환엄중뇌손상조（19례）화부환엄중전신질병조（30례）]급영양상황（영양량호혹영양불량）대aEEG적영향，이급규정태령족월시두로B초급규정태령6개월후Gesell량표평개여aEEG결과이상적관계。채용χ2검험、량독립양본t검험급Logistic회귀분석진행통계학분석。결과규정태령족월시，52%（79/153）적조산인aEEG체도정상족월인수평，기여48%（74/153）aEEG이상。상대평은조산인수착태령증가，aEEG이상솔유＜30주조적3/6축점강지34≤~≤36+6주조적35%（13/37），단차이무통계학의의（χ2=1.998， P=0.353）。엄중뇌손상조조산인aEEG결과이상솔고우상대평은조산인[14/19여44%（46/104），χ2=5.578，P=0.024]。재상대평은조산인조，궁내영양불량자적aEEG이상솔여영양량호자비교，차이무통계학의의[46%（19/41）여43%（27/63），χ2=0.122，P=0.727]；궁외영양불량자적aEEG이상솔여영양량호자비교，차이야무통계학의의[52%（13/25）여42%（33/79），χ2=0.805， P=0.369]。조산인엄중뇌손상시aEEG결과이상적독립위험인소（OR=3.453，95%CI：1.177~10.132， P=0.024）。aEEG검사결과여두로B초검사결과적부합솔위57%（56/98），여Gesell발육량표평고결과부합솔위50%（10/20）。결론조산인생후조기뇌공능가능존재추간성발육，단수도출생태령화뇌손상엄중정도적영향，결합기타평개방법가공동반영조산인생후조기신경계통발육정황。
Objective To study the characteristics and its risk fastors of brain development of the preterm infant early after birth in amplitude-integrated electroencephalography(aEEG). Methods The 153 preterm infants who had seen a doctor in Peking University First Hospital from April 2009 to August 2013 accepted the aEEG check at term of corrected gestational age ( ≥ 38 weeks but < 42 weeks of corrected gestational age). The risk factors of brain development, such as gestational age ( < 30, 30 ≤ - ≤ 33+6 and 34≤-≤36+6 weeks), clinical informations [relatively stable group including 104 cases without any serious complications or brain injury, the group only suffering from a serious brain injury (19 cases), and the group only suffering from severe systemic disease (30 cases)] and nutrition (good or malnutrition), were analyzed. Also the relationship between the aEEG and the cranial ultrasound detected at the same time and the Gesell Developmental Scale at six months of corrected gestational age. Theχ2 test, two independent samples t-test and Logistic regression analysis were used for statistical analysis. Results The aEEG of 52%(79/153) cases reached the level of normal full-term newborn at term of corrected gestational age, only 48% (74/153) were abnormal. The abnormal rate of aEEG results in relatively stable preterm infants decreased from 3/6 (<30 weeks) to 35%(13/37) at 34 ≤ - ≤ 36+6 weeks, but the difference was not statistically significant (χ2=1.998, P=0.353). The abnormal rate of aEEG results in the group suffering from a serious brain injury was higher than the relatively stable preterm infants [14/19 vs 44%(46/104) ,χ2=5.578, P=0.024]. In relatively stable preterm infants, there was no difference of the abnormal rate of the aEEG results between intrauterine malnutrition group and good nutrition group [46%(19/41) vs 43%(27/63),χ2=0.122, P=0.727]. Neither was between extrauterine malnutrition group and good nutrition group [52%(13/25) vs 42%(33/79),χ2=0.805, P=0.369]. Serious brain injury was independent risk factor of abnormal aEEG (OR=3.453, 95%CI: 1.177-10.132, P=0.024). The coincidence rate of aEEG and the cranial ultrasound examination or the scores of Gesell Developmental Scale was 57%(56/98) and 50%(10/20), respectively. Conclusions The brain catch-up development may appears early after birth in preterm infants, which are impaired by lower gestational age and the severe brain injury. It is more effective of aEEG for evaluating the brain development of preterm infants when combines with other methods.