早产儿振幅整合脑电图的影响因素

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目的探讨早产儿振幅整合脑电图(aEEG)的影响因素。方法在出生12 h内采用NicoletOne脑功能监测仪对71例早产儿进行aEEG描记。根据aEEG背景活动的方式及有无惊厥样活动,将aEEG结果判断为正常和异常aEEG(包括轻度异常及重度异常)。床旁颅脑超声监测脑损伤的发生。分析胎龄、出生体质量、窒息、低氧血症、辅助通气及脑损伤对早产儿aEEG的影响。结果 1.早产儿71例中,正常aEEG 40例,异常aEEG 31例。2.胎龄<34周者54例,正常aEEG 25例,异常aEEG 29例(53.7%);≥34周者17例,正常aEEG 15例,异常aEEG 2例(11.8%);2组aEEG异常率比较差异有统计学意义(χ2=9.245 2,P<0.01)。3.出生体质量<1.5 kg者25例,正常aEEG 8例,异常aEEG 17例(68.0%);出生体质量≥1.5 kg者46例,正常aEEG 32例,异常aEEG14例(30.4%);2组aEEG异常率比较差异有统计学意义(χ2=9.291 9,P<0.001)。4.产时有窒息者36例,正常aEEG 15例,异常aEEG 21例(58.3%);无窒息者35例,正常aEEG 25例,异常aEEG 10例(28.6%);2组aEEG异常率比较差异有统计学意义(χ2=6.390 4,P<0.05)。5.低氧血症24例,正常aEEG 16例,异常aEEG 8例(33.3%);无低氧血症者47例,正常aEEG 24例,异常aEEG 23例(48.9%);2组aEEG异常率比较差异无统计学意义(χ2=1.572 4,P>0.05)。6.辅助通气者19例,正常aEEG 8例,异常aEEG 11例(57.9%);未辅助通气者52例,正常aEEG 32例,异常aEEG 20例(38.5%);2组aEEG异常率比较差异无统计学意义(χ2=2.136 4,P>0.05)。7.有脑损伤者51例,正常aEEG 24例,异常aEEG 27例(52.9%);无脑损伤者20例,正常aEEG 16例,异常aEEG 4例(20.0%);2组aEEG异常率比较差异有统计学意义(χ2=6.337 5,P<0.05)。结论胎龄和出生体质量对早产儿aEEG有显著影响。小胎龄、低出生体质量以及出生时窒息和脑损伤的早产儿异常aEEG的发生率高。在分析早产儿aEEG时应考虑胎龄、出生体质量、窒息及脑损伤等生理病理因素的影响。 Objective To investigate the influential factors of amplitude-integrated electroencephalography (aEEG) in preterm infants. Methods A total of 71 preterm infants were enrolled in aEEG using NicoletOne brain function monitor within 12 hours of birth. The aEEG results were judged as normal and abnormal aEEG (including mild and severe abnormalities) based on the pattern of aEEG background activity and the presence or absence of convulsion-like activity. Bedside cranial ultrasound monitoring of brain injury. The effects of gestational age, birth weight, asphyxia, hypoxemia, assisted ventilation and brain injury on aEEG in preterm infants were analyzed. Among the 71 preterm infants, there were 40 cases of normal aEEG and 31 cases of abnormal aEEG. There were 54 cases of gestational age <34 weeks, 25 cases of normal aEEG, 29 cases of abnormal aEEG (53.7%), 17 cases of ≥34 weeks, 15 cases of normal aEEG, 2 cases of abnormal aEEG (11.8%), 2 cases of abnormal aEEG The difference was statistically significant (χ2 = 9.245 2, P <0.01). (2) There were 25 cases with birth weight <1.5 kg, 8 cases with normal aEEG, 17 cases with abnormal aEEG (68.0%), 46 cases with birth weight≥1.5 kg, 32 cases with normal aEEG and 14 cases with abnormal aEEG (30.4%). Group aEEG abnormal rate was statistically significant difference (χ2 = 9.291 9, P <0.001). There were 36 cases of obstructive labor, 15 cases of normal aEEG, 21 cases of abnormal aEEG (58.3%), 35 cases of asphyxia, 25 cases of normal aEEG and 10 cases of abnormal aEEG (28.6%). The difference was statistically significant (χ2 = 6.390 4, P <0.05). 24 cases of hypoxemia, normal aEEG in 16 cases, abnormal aEEG in 8 cases (33.3%); no hypoxemia in 47 cases, normal aEEG in 24 cases, abnormal aEEG in 23 cases (48.9%); 2 aEEG abnormalities The difference was not statistically significant (χ2 = 1.572 4, P> 0.05). There were 19 cases of assisted ventilation, 8 cases of normal aEEG, 11 cases of abnormal aEEG (57.9%); 52 cases of unassisted ventilation, 32 cases of normal aEEG, 20 cases of abnormal aEEG (38.5%); No statistical significance (χ2 = 2.136 4, P> 0.05). There were 51 cases of brain injury, 24 cases of normal aEEG, 27 cases of abnormal aEEG (52.9%), 20 cases of no brain injury, 16 cases of normal aEEG and 4 cases of abnormal aEEG (20.0%). The difference was statistically significant (χ2 = 6.337 5, P <0.05). Conclusion The gestational age and birth weight have a significant effect on aEEG in preterm infants. The incidence of abnormal aEEG in small gestational age, low birth weight, and asphyxia and brain injury at birth is high. When analyzing aEEG in preterm infants, the effects of gestational age, birth weight, asphyxia and brain injury and other physiological and pathological factors should be considered.
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