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目的采用振幅整合脑电图(aEEG)研究不同受孕龄(PMA)新生儿脑成熟度的发育规律。方法选取无特殊疾病、适于胎龄、PMA24～52周的新生儿为研究对象,根据PMA进行分组。通过aEEG监测仪采集脑电信号,得到aEEG图形,分析活动睡眠(AS)期和安静睡眠(QS)期波幅的变化规律。计算样本熵,观察脑电活动复杂度的变化规律。结果 165例新生儿进入分析。①睡眠周期随PMA的增长逐渐建立。PMA<27周aEEG表现为抑制背景下偶尔出现的爆发活动,无明显睡眠周期;PMA～32周观察到初步的AS期与QS期;PMA>37周,出现明显可辨的AS-QS期交替波形。②随PMA的增加,AS期和QS期的振幅整体呈上升趋势。PMA<37周,振幅逐步增加;PMA～44周振幅维持相对稳定,AS期振幅波动于6～20μV,QS期振幅波动于7～25μV;PMA>44周,AS期和QS期振幅进一步增高。③PMA<32周,随PMA的增加,AS期和QS期的样本熵值(P50)整体呈上升趋势,但数值波动较大,缺乏规律性;随着PMA的增加,样本熵值进一步增加,AS期的样本熵值增加程度高于QS期;PMA～36周样本熵值在AS期和QS期分别达到高峰,且波动幅度减小;PMA>37周AS期和QS期的样本熵值均出现下降趋势,活动形式趋于规律化。结论随着PMA的增加,新生儿脑电生理活动逐步发育成熟。aEEG和样本熵能够反映脑电活动的成熟度,在新生儿脑功能监测中有应用价值。
Objective To study the development of brain maturation in neonates with different gestational age (PMA) by amplitude integrated electroencephalography (aEEG). Methods Newborns with no specific disease, suitable for gestational age and PMA from 24 to 52 weeks were selected as the research subjects and grouped according to PMA. EEG signals were collected by aEEG monitor, and the aEEG pattern was obtained. The changes of amplitude during active sleep (AS) and quiet sleep (QS) were analyzed. The sample entropy was calculated and the change rule of EEG activity complexity was observed. Results 165 newborns entered the analysis. ① sleep cycle with the gradual establishment of PMA growth. PMA <27 weeks aEEG showed occasional outbreak activity in the background, with no significant sleep cycle; PMA ~ 32 weeks observed initial AS and QS; PMA> 37 weeks, there was a clear discernible AS-QS alternation Waveform. With the increase of PMA, the amplitude of AS phase and QS phase showed an overall upward trend. The amplitudes of PMA were stable at 37 weeks. The amplitude of PMA was steady at 44 weeks, the amplitude of AS was 6-20μV, the amplitude of QS was 7-25μV, the amplitude of PMA was 44 weeks, and the amplitude of AS and QS was further increased. ③PMA <32 weeks, with the increase of PMA, sample entropy value (P50) in AS period and QS period showed an overall upward trend, but the values fluctuated greatly and lacks regularity. With the increase of PMA, the sample entropy value further increased. AS The sample entropy increased more than that of QS. The sample entropy of PMA 36 weeks peaked in the period of AS and QS, respectively, and the amplitude of fluctuation decreased. The sample entropy of PMA> 37 weeks AS and QS appeared Decline, activities tend to be regulated. Conclusion With the increase of PMA, neonatal brain electrophysiology gradually mature. aEEG and sample entropy can reflect the maturity of EEG activity and have value in monitoring neonatal brain function.