摘要目的 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.

abstractsObjective 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.