足月新生儿缺氧缺血性脑病视频振幅整合脑电图的临床分析

发布时间：2018-06-15 05:09

本文选题：足月儿 + 神经行为评分　；参考：《延安大学》2017年硕士论文

【摘要】：目的探讨早期不同临床分度的新生儿缺氧缺血性脑病(hypoxic-ischemic encephalopathy,HIE)脑电生理特点及早期脑功能监测在诊断HIE、评估神经系统预后中的作用,为临床早期诊断缺氧缺血性脑病提供理论依据。方法选取延安大学附属医院2014年12月至2016年11月出生的6小时以内入院临床诊断为HIE的患儿58例,根据临床表现分为轻度、中度、重度,选取同期非脑损伤足月儿21例作为对照组,在入院后6小时内进行振幅整合脑电图(amplitudeintegrated electroencephalogram,aEEG)监测,持续监测20-24小时。所有患儿在生后3-7天进行头颅磁共振检查(magnetic resonance imaging,MRI);并在出生3天、2周、4周对所有患儿进行神经行为(Neonatal Behavioral Neurological Assessment,NBNA)评分。分析各组患儿背景波最高、最低电压、睡眠觉醒周期(sleep-wake circle,SWC)、背景活动等脑功能的电生理特点;aEEG分类结果、头颅MRI分度与HIE临床分度之间的关系;HIE临床分度、aEEG分类结果与NBNA评分之间的关系。结果1.四组患儿最高电压均值的差异明显,有统计学意义(P0.05);其中,对照组与轻度HIE组最高电压均值的差异不明显,无统计学意义(P0.0125);其余各组间最高电压均值的差异明显,有统计学意义(P0.0125)。2.四组患儿最低电压均值的差异明显,具有统计学意义(P0.05);其中,对照组与轻度HIE组最低电压均值的差异不明显,无统计学意义(P0.0125);其余各组间最低电压均值的差异明显,有统计学意义(P0.0125)。3.四组患儿SWC总体分布的差异明显,有统计学意义(P0.05);其中,对照组与轻度HIE组SWC分布的差异不明显,无统计学意义(P0.0083);其余各组间SWC分布的差异明显,有统计学意义(P0.0083);用speraman等级相关分析,相关系数为0.861,P0.001。4.四组患儿背景活动的总体分布差异明显,有统计学意义(P0.05);其中,对照组与轻度HIE组背景活动分布的差异不明显,无统计学意义(P0.0083);其余各组间背景活动的分布差异明显,有统计学意义(P0.0083);用speraman等级相关分析,相关系数为0.855,P0.001。5.四组患儿aEEG分类结果总体分布的差异明显,有统计学意义(P0.05);其中,对照组与轻度HIE组aEEG分类结果差异不明显,无统计学意义(P0.0083);其余各组间aEEG分类结果分布差异明显,有统计学意义(P0.0083);用speraman等级相关分析,相关系数为0.745,P0.001。6.四组患儿头颅MRI分度的总体分布的差异明显,有统计学意义(P0.05);任意两组间头颅MRI分度的分布差异明显,有统计学意义(P0.0083);用speraman等级相关分析,相关系数为0.937,P0.001。7.不同aEEG结果患儿头颅MRI分度的总体分布的差异明显,有统计学意义(P0.05);任意两组间头颅MRI分度的分布差异均明显,有统计学意义(P0.017);用speraman等级相关分析,相关系数为0.948,P0.001。8.四组患儿3天、2周、4周NBNA评分的均值差异明显,有统计学意义(P0.05);任意两组在3天、2周、4周NBNA评分的均值差异明显,有统计学意义(P0.0125)。9.不同aEEG结果的患儿在3天、2周、4周时NBNA评分的均值差异明显,有统计学意义(P0.05);任意两组间患儿在3天、2周、4周NBNA评分的均值差异均明显,有统计学意义(P0.017)。结论1.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临床分度愈重,电压上升或者下降的幅度愈明显。2.SWC、背景活动与HIE临床分度一致性良好,具有密切的相关性。3.aEEG分类结果、头颅MRI分度与HIE临床分度任意两者之间一致性良好,具有密切的相关性。4.aEEG可以更早、更及时发现脑功能异常,有助于临床早期协助诊断HIE,可以作为HIE早期的诊断指标。5.头颅MRI分度与HIE临床分度一致,但是aEEG的时效性、便利性均优于头颅MRI。6.不同程度HIE患儿神经行为发育不同,轻度HIE组较中重度HIE组患儿的神经系统功能恢复较快,值得临床继续进行HIE临床分度与神经系统远期发育进行深入研究。7.aEEG分类结果不同,患儿在新生儿期不同年龄的神经行为发育不同。aEEG结果正常组的患儿较aEEG结果轻度异常组和重度异常组患儿的神经系统功能恢复快,值得临床继续进行不同aEEG结果与神经系统远期发育进行深入研究。
[Abstract]:Objective to investigate the electrophysiological characteristics of hypoxic-ischemic encephalopathy (HIE) and early brain function monitoring in the diagnosis of HIE and evaluate the prognosis of the nervous system in early diagnosis of neonatal hypoxic ischemic encephalopathy (HIE), and to provide a theoretical basis for the early diagnosis of hypoxic ischemic encephalopathy. Method selected Affiliated Hospital of Yan'an University, 2014 In the 6 hours from December to November 2016, 58 children diagnosed with HIE were admitted to hospital. According to their clinical manifestations, they were divided into mild, moderate and severe. 21 cases of non brain injury in the same period were selected as the control group. The amplitude integrated electroencephalogram (amplitudeintegrated electroencephalogram, aEEG) monitoring and continuous monitoring 2 within 6 hours after admission were carried out. 0-24 hours. All children underwent magnetic resonance imaging (MRI) at 3-7 days after birth; and all children were scored at 3, 2, and 4 weeks of birth (Neonatal Behavioral Neurological Assessment, NBNA). The highest, lowest voltage, and sleep awakening cycle (sleep-wake circle, S) were analyzed. WC), the electrophysiological characteristics of the brain function such as background activity, aEEG classification results, the relationship between the head MRI score and the clinical score of HIE; the relationship between the HIE clinical score, the aEEG classification result and the NBNA score. Results 1. the difference of the mean value of the highest voltage in the four groups was significant (P0.05); among them, the highest voltage of the control group and the mild HIE group The difference of mean value was not significant (P0.0125), and the difference of the average value of the highest voltage between the other groups was obvious. The difference of the mean value of the minimum voltage in the four groups of.2. groups was statistically significant (P0.05), and the difference of the mean value of the minimum voltage in the control group and the light HIE group was not significant (P0.01). 25): the difference of the mean value of the lowest voltage between the other groups was obvious, and there was significant difference in the overall distribution of SWC in the children of.3. four groups (P0.0125), and there was statistical significance (P0.05), and there was no significant difference in the distribution of SWC between the control group and the mild HIE group (P0.0083), and the difference of SWC distribution among the other groups was significant (P). 0.0083); with speraman grade correlation analysis, the correlation coefficient was 0.861, and the overall distribution of background activities in the group P0.001.4. four was significant (P0.05), and there was no significant difference in the distribution of background activity between the control group and the mild HIE group (P0.0083); the distribution of background activities in the other groups was distinct, and there was a significant difference between the other groups. Study significance (P0.0083); with speraman grade correlation analysis, the correlation coefficient was 0.855, and the overall distribution of aEEG classification results in P0.001.5. four groups was significant (P0.05). The difference of aEEG classification results between the control group and the mild HIE group was not obvious, no statistical significance (P0.0083), and the distribution difference of the aEEG classification between the other groups was different. Obviously, there was statistical significance (P0.0083); the correlation coefficient was 0.745 with speraman level correlation analysis, and the total distribution of head MRI diversity in group P0.001.6. four was significant (P0.05); the distribution difference between two groups of two groups was significant, statistically significant (P0.0083); correlation analysis of speraman grade, correlation line The total distribution of head MRI diversity in children with different aEEG results was 0.937, with significant difference (P0.05), and the difference in the distribution of head MRI scores between any two groups was significant (P0.017); the correlation coefficient was 0.948 with speraman grade correlation analysis, 3 days in group P0.001.8. four, 2 weeks and 4 weeks in NBNA scores. The value difference was significant (P0.05); the mean difference in the mean value of NBNA scores in any two groups at 3, 2, and 4 weeks was significant. The mean difference in the mean value of NBNA scores at 3, 2, and 4 weeks in children with different aEEG results was statistically significant (P0.05); the mean difference in NBNA scores at 3 days, 2 weeks, and 4 weeks in any of the two groups of children was different. It was statistically significant (P0.017). Conclusion 1. with the aggravation of HIE, the maximum voltage increased gradually and the minimum voltage decreased gradually. The more the HIE clinical score was, the more obvious the amplitude of the voltage or the decrease of the voltage was.2.SWC, the background activity was in good agreement with the HIE clinical diversity, with a close correlation of the.3.aEEG classification results and the MRI score of the head. There is a good consistency between the degree and the HIE clinical diversity, with a close correlation,.4.aEEG can be earlier, more timely detection of abnormal brain function, help the early diagnosis of HIE, and can be used as a diagnostic indicator of the early HIE,.5. head MRI degree is consistent with the HIE clinical diversity, but aEEG's aging and convenience are better than the skull MRI.6.. The neurobehavioral development of children with HIE in different degrees is different. The nervous system function of the mild HIE group is faster than that of the moderate severe HIE group. It is worth to continue to carry on the clinical division of the HIE and the long-term development of the nervous system. The results of the.7.aEEG classification are different. The neurobehavioral development of the children at different ages of the newborn is different from the.AEEG results. The neurological function of the children in the normal group was faster than that in the mild abnormal group and the severe abnormal group of the aEEG. It is worth to carry on the further study of the different aEEG results and the long-term development of the nervous system.
【学位授予单位】：延安大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R742

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