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目的探讨振幅整合脑电图(a EEG)在足月新生儿脑损伤早期诊断中的意义。方法选择92例足月窒息新生儿(窒息组根据窒息程度分为轻度窒息及重度窒息)及20例健康足月儿(对照组),均于出生后6 h内开始进行a EEG监测,每次持续时间≥4 h,分析a EEG的背景活动、睡眠-觉醒周期(SWC)及痫样活动的特点,按a EEG结果将其分为正常、轻度异常、重度异常3种。结果窒息组92例患儿中轻度新生儿缺氧缺血性脑病(HIE)21例,中度HIE 5例,重度HIE 7例。对照组的背景活动均正常;19例为成熟SWC,1例为不成熟SWC;均无癫痫样活动;均为正常a EEG。窒息组中a EEG背景活动异常39例;轻度窒息者中66例为成熟SWC,4例为不成熟SWC,2例无SWC;3例偶次痫样放电。重度窒息者中有7例为成熟SWC,4例为不成熟SWC,9例无成熟SWC;3例偶次放电,4例反复放电,2例癫痫持续状态。轻度HIE患儿,a EEG正常者19例,轻度异常者2例;中度HIE患儿a EEG正常者1例,轻度异常者2例,重度异常者2例。重度HIE患儿a EEG均重度异常。a EEG的背景活动、SWC异常程度均与窒息和脑损伤程度呈正相关(r=0.312,r=0.483;r=0.885,r=0.708;P<0.01)。结论a EEG变化与围生期窒息及窒息后脑损伤密切相关,能作为脑损伤早期诊断和治疗指导的主要参考指标,为早期干预提供理论依据。
Objective To investigate the significance of amplitude-integrated electroencephalography (aEEG) in the early diagnosis of full-term neonatal brain injury. Methods Ninety-two neonates with term asphyxia (asphyxia group, mild asphyxia and severe asphyxia group) and 20 healthy term children (control group) were enrolled in this study. EEG monitoring was started within 6 hours after birth, The duration of follow-up was ≥4 h. The background activity, sleep-wake cycle (SWC) and epileptiform activity of a EEG were analyzed. According to the results of a EEG, they were divided into three groups: normal, mild and severe. Results Among the 92 children with asphyxia group, 21 were mild hypoxic-ischemic encephalopathy (HIE), 5 moderate HIE and 7 severe HIE. The background activities of the control group were normal; 19 cases of mature SWC, 1 cases of immature SWC; no epileptic-like activity; are normal a EEG. In the asphyxia group, there were 39 cases of abnormal EEG background activity; 66 cases of mild asphyxia were mature SWC, 4 cases of immature SWC, 2 cases of SWC; 3 cases of occasional epileptiform discharge. Severe asphyxiation were 7 cases of mature SWC, 4 cases of immature SWC, 9 cases of immature SWC; 3 cases of even discharge, 4 cases of repeated discharge, 2 cases of status epilepticus. There were 19 cases with mild EEG and 2 cases with mild abnormality in mild HIE, 1 case with normal EEG in 2 cases with mild EEG, 2 cases with mild abnormalities and 2 cases with severe abnormalities. Severe HIE in children with a EEG were severe abnormalities. aEEG background activity, SWC abnormalities were positively correlated with asphyxia and brain injury (r = 0.312, r = 0.483; r = 0.885, r = 0.708; P <0.01). Conclusions The changes of a-EEG are closely related to asphyxiation and post-asphyxial brain injury, and can be used as the main reference for the early diagnosis and treatment of brain injury. It provides a theoretical basis for early intervention.