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目的探讨足月新生儿缺氧缺血性脑病(HIE)的早期脑功能特点,观察早期脑功能监测在HIE临床分度、评估神经系统预后的作用。方法选取延安大学附属医院2014年12月-2016年12月出生的6 h以内入院的患儿58例,根据HIE的诊断标准分为轻度(H1组)、中度(H2组)、重度(H3组),选取同期非脑损伤足月儿21例作为对照组(H0),在入院后6 h内进行振幅整合脑电图(aEEG)监测,持续监测20~24 h。分析a EEG的背景波最高振幅/最低振幅、睡眠觉醒周期(SWC)、背景活动、a EEG结果、头颅磁共振成像(MRI)结果 5项指标;在生后3~7 d进行头颅MRI检查;并在出生3 d及2、4周进行神经行为测定(NBNA),对不同程度脑损伤患儿的神经行为预后进行评估。结果 (1)4组患儿最高/最低电压均值的差异具有统计学意义(F=40.10/256.6,P<0.05);组间比较,H0和H1组的最高/最低电压组间差异无统计学意义(P>0.05),余各组间的最高/最低电压比较差异有统计学意义(P<0.05)。(2)4组患儿的睡眠觉醒周期(H=62.47,P<0.05)、背景活动(H=66.92,P<0.05)、aEEG结果 (H=57.97,P<0.05)、头颅MRI分度(H=68.71,P<0.05)之间的差异有统计学意义,其相关性分别为:r=0.861,P<0.001;r=0.855,P<0.001;r=0.745,P<0.001;r=0.937,P<0.001。(3)H0、H1、H2、H3组患儿3 d及2、4周NBNA评分均值组间差异均有统计学意义(均P<0.05);任意两组间患儿NBNA评分均值在3 d及2、4周比较差异均有统计学意义(均P<0.05)。结论随着HIE临床程度的加重,最高电压逐渐上升,最低电压逐渐下降,HIE临床程度越重,电压上升或者下降的幅度越明显。通过对不同程度的脑损伤患儿进行脑功能监测,分析最高/最低电压、SWC、背景活动、aEEG及头颅MRI结果可为患儿预后判断提供科学依据。
Objective To investigate the characteristics of early brain function of term neonates with hypoxic-ischemic encephalopathy (HIE) and to observe the clinical evaluation of early brain function in HIE and to evaluate the prognosis of nervous system. Methods Fifty-eight children hospitalized within 6 hours from December 2014 to December 2016 in Yan’an University Affiliated Hospital were divided into two groups according to the diagnostic criteria of HIE: mild (H1), moderate (H2) and severe H3 group). 21 non-brain injury full-term infants were selected as control group (H0) during the same period. Amplitude integrated electroencephalography (aEEG) monitoring was performed within 6 h after admission, and the monitoring was continued for 20-24 h. The maximum amplitude / minimum amplitude of background wave, SWC, background activity, a EEG and MRI findings of a EEG were analyzed. Head MRI was performed 3 to 7 days after birth. Neurobehavioral testing (NBNA) was performed at 3 days and 2 and 4 weeks of life to evaluate the neurobehavioral outcome in children with different degrees of brain injury. Results (1) The difference of maximum / minimum voltage between 4 groups was statistically significant (F = 40.10 / 256.6, P <0.05). There was no significant difference between the groups of H0 and H1 (P> 0.05), the difference between the highest and the lowest voltage in each group was statistically significant (P <0.05). (2) The wakefulness of sleep (H = 62.47, P <0.05), background activity (H = 66.92, P <0.05), aEEG result (H = 57.97, H = 68.71, P <0.05), the correlation was statistically significant (r = 0.861, P <0.001; r = 0.855, P <0.001; r = 0.745, P <0.001; r = 0.937 , P <0.001. (3) There was significant difference in NBNA score at 3 d, 2, 4 weeks between H0, H1, H2, H3 groups (all P <0.05) And 2, 4 weeks were statistically significant differences (all P <0.05). Conclusions With the increase of clinical level of HIE, the maximum voltage gradually increases and the minimum voltage gradually decreases. The more severe HIE is, the more obvious the voltage rises or falls. Monitoring of brain function in children with different degrees of brain injury, analysis of maximum / minimum voltage, SWC, background activity, aEEG and cranial MRI results may provide a scientific basis for the prognosis of children.