【作者】 魏巍；

【导师】 尹晓娟；

【作者基本信息】 大连医科大学 ， 儿科学， 2013， 硕士

【摘要】 目的：通过研究振幅整合脑电图（aEEG）在缺氧缺血性脑病（HIE）病程中的变化特点，探讨aEEG在HIE早期诊治及远期预后中的应用价值。方法：选择2011年3月至2012年1月在我院新生儿监护病房（NICU)住院的120例、胎龄在34周～42+2周、确诊为HIE的新生儿为aEEG观测组和非观测组研究对象。120例HIE患儿随机分为aEEG观测组和非观测组，每组60例。各组中再根据HIE严重程度分为轻度、中度、重度3个亚组，每亚组20例。对所有HIE患儿按照中华医学会制定的“三对症、三支持”方案进行治疗，aEEG观测组患儿根据aEEG增加相应治疗。本院产科出生的60例正常新生儿作为对照组。aEEG观测组HIE患儿分别在生后第1天、3天、14天及28天时描记aEEG，对照组在生后第1天及3天描记aEEG。根据aEEG背景活动将aEEG分为正常、轻度异常和重度异常。aEEG观测组及非观测组HIE患儿在第3、14及28天时行新生儿神经行为测定（NBNA）评分，其中早产儿在矫正胎龄满40周时行NBNA评分，NBNA满分40分，≥35分为合格，＜35分为不合格。对三组病例在矫正胎龄满3月、6月及12月时进行随访，随访内容包括磁共振成像（MRI）、丹佛发育筛查测验（DDST）以及神经系统后遗症。所有数据用SPSS17.0软件包进行统计分析，数据以均数±标准差(x±SD)表示，经正态性检验和方差齐性检验后，采用F检验；计数资料及频率比较采用χ2检验；配对资料比较采用t检验；两组间相关度比较采用Spearman等级相关分析。P＜0．05示为有统计学意义。结果:1.aEEG观测组第1天时相点aEEG：正常6例，均为轻度HIE（100%）；轻度异常29例，其中轻度HIE14（48.3%）例，中度HIE10（34.5%）例，重度HIE5（17.2%）例；重度异常25例，其中中度HIE10（40%）例，重度HIE15（60%）例。aEEG与HIE临床分度存在强正相关（r=0.843，P＜0.01）。2.aEEG观测组第3天时相点aEEG：正常8例，其MRI均为轻度异常（100%）；轻度异常30例，其MRI轻度异常11（36.7%）例，中度异常19（63.3%）例；重度异常22例，其MRI中度异常2（9.1%）例，重度异常20（90.1%）例。aEEG与MRI存在强正相关（r=0.876，P＜0.01）。3.在第3天和第14天时相点aEEG观测组与非观测组NBNA评分无统计学意义(P＞0.05），而在第28天时相点，aEEG观测组与非观测组NBNA评分有统计学意义（P＜0.05）。4.在第1、3、14及28天时相点，观测组aEEG与矫正胎龄满12月时预后均存在强正相关（r=0.832、0.857、0.778、0.743，P＜0.01）。在第1天时相点，重度异常aEEG预测HIE异常预后的敏感度为95.8%，特异度为94.4%，阳性预测值为92%，阴性预测值为97.1%。5.aEEG观测组致残率（13.8%）显著低于非观测组（23.2%）；aEEG观测组痊愈率（60%）显著高于非观测组（40%）；aEEG观测组和非观测组远期预后有统计学意义（χ~2=4.107，P＜0.05）。结论：1.aEEG与HIE临床分度具有极好的相关性，可以早期协助诊治HIE。2.aEEG与MRI具有极好的相关性，aEEG可以替代MRI早期协助诊断HIE。3.aEEG可以用于预测HIE远期预后，早期aEEG严重者，其远期预后差。更多还原

【Abstract】 Objective: To explore the application value of the aEEG in early diagnosis andtreatment of HIE and long-term prognosis by researching on the changing characteristicof amplitude integrated Encephalopathy (aEEG) in the pathogenesis ofhypoxic-ischemic encephalopathy (HIE).Methods: A total of120cases of newborns with HIE who were hospitalized fromMarch2011to January2012were selected from neonatal intensive care unit (NICU)ofour hospital, and their gestational ages were from34weeks to42+2weeks.120cases ofnewborns were randomly dividing into the observation group with aEEG and non-observation group, each group having60cases. According to the severity of HIE, eachgroup was divided into mild,moderate,and severe subgroup, each subgroup having20cases.All the treatment was in accordance with the principle of Chinese MedicalAssociation,"three symptomatic，three support", and corresponding treatment wasadded into the observation group with aEEG.A total of60normal newborns born indepartment of obstetrics of our hospital were selected as control group. aEEG wasrespectively traced at time points(1,3,14and28day) after birth for observation groupwith aEEG and traced at time points(1and3day) after birth for control group. Theoutcome of aEEG was divided into normal, mildly abnormal and severely abnormalaEEG according to Background activity. The observation group with aEEG andnon-observation group took the Neonatal Behaviral Neurologieal Assessment (NBNA)assessment at time points(3,14and28day) after birth, and the preterm newborns tookthe assessment after corrected gestational age of full40weeks. Define40as the fullpoint for NBNA score, more than35as qualified and below35as unqualified.Doingfollow-up research for three groups after corrected gestational age of3months,6months and12months, the follow-up investigation including magnetic resonance imaging(MRI), Denver Developmental Screening Test (DDST) and nervous system sequelae.All data was analyzed by SPSS17.0, the results were expressed as mean±standarddeviation (x±SD), after the test of normality and variance test of homogeneity, we usethe F-test and we use Chi-square inspection to do the comparison of the frequency, wetake t test for the comparison data and Spearman rank analysis for correlation of the twogroups. P <0.05is shown as statistically significant.Result:1.The results of the observation group with aEEG at1day times point:6cases withmild HIE (100%) were normal aEEG.29cases were mildly abnormal aEEG,14(48.3%)cases of whom had mild HIE,10(34.5%)cases of whom had moderate HIE and5(17.2%) cases of whom had severe HIE.25cases were severely abnormal aEEG,10(40%)cases of whom had moderate HIE,15(60%)cases of whom had severe HIE.There was strong positive correlation between aEEG and HIE clinical indexing (r=0.843, P <0.01).2.The results of the observation group with aEEG at3day times point:8cases withmild MRI (100%) were normal aEEG.30cases were mildly abnormal aEEG,11(36.7%)cases of whom had mild MRI,19(63.3%)cases of whom had moderate MRI.22cases were severely abnormal aEEG,2(9.1%)cases of whom had moderate MRI,20(90.1%)cases of whom had severe MRI. There was strong positive correlationbetween aEEG and MRI(r=0.876, P <0.01).3. At3day and14day time points,it was not statistically significant for the NBNAscore between observation group with aEEG and non-observation group (P＞0.05)while it was statistically significant for the NBNA score between observation groupwith aEEG and non-observation group at28day time poin t(P＜0.05).4.At1，3，14and28day time points, The aEEG results for observation group witha EEG had strong positive correlation with prognosis after corrected gestational age of12month(r=0.832、0.857、0.778、0.743，P＜0.01). At1day time points, the severelyabnormal aEEG could forecast abnormal prognosis and the susceptibility is95.8%, thespecificity is94.4%,the positive predictive value is92%,the negative predictive value is97.1%.5. The disable rate in the observation group with aEEG (13.8%) was significantly lower than that in the non-observation group (23.2%); the cure rate (60%) in theobservation group with aEEG was significantly higher than that in the non-observationgroup (40%). The long-term prognosis of the observation group with aEEG and thenon-observation group was statistically significant (χ~2=4.107, P <0.05).Conclusion:1. The aEEG has excellent correlation with HIE clinical indexing, and can assist inearly diagnosis and treatment of HIE.2. The aEEG has excellent correlation with MRI and it can replace MRI to do earlydiagnosis and treatment of HIE.3. AEEG can be used to predict long-term prognosis of HIE, if the early results ofthe aEEG is poor, the long-term prognosis will be poor.更多还原