视频脑电图对新生儿惊厥的诊断价值及预后评估意义

摘要

Objective To study the clinical value of video-electroencephalogram (VEEG) on the diagnosis and prognosis of neonatal seizure.Method From January 2016 to December 2017,the medical records of 118 neonates who had seizure and received VEEG in our hospital were collected.The results of VEEG and medical records were analyzed using x2 test,Fisher's exact test or rank sum test.Result Among the 118 neonates,94 cases(79.6％) had abnormal VEEG results,including 59 mildly abnormal cases,21 moderately abnormal cases,and 14 severely abnormal cases.The characteristics of mildly abnormal VEEG was delayed mature,and moderately and severely abnormal VEEG were paroxysmal abnormal activities.All of the severely abnormal VEEGs showed abnormal background activities.The incidence of abnormal background activities of severely abnormal group was higher than mildly and moderately abnormal group,the difference was significant (P＜0.001).Neonates with abnormal background activities had higher rates of epileptic seizure and delayed maturation than those with normal background,and the differences were significant (P＜0.001).Among 32 neonates with paroxysmal events,17 cases had non-epileptic events including subtle seizures,myoclonus seizures,and symmnetrical tonic seizures;15 cases had epileptic electrographic seizures and electro-clinical seizures,12 cases had focal seizures.The degree of abnormal VEEG had positive correlations with the incidences of epileptic seizures and delayed maturation (P＜0.001).Conclusion Neonates with seizure has higher rate of abnormal VEEG.Non-epileptic events presents as subtle seizures and myoclonus seizures,and epileptic seizures as focal seizures.The background activities of neonatal VEEG has important predictive value for prognosis.The worse the VEEG is,the higher the possibility of epileptic seizure and delayed maturation.%目的 探讨视频脑电图(video-electroencephalogram,VEEG)监测在新生儿惊厥中的诊断价值及预后评估意义.方法 回顾性选取2016年1月至2017年12月南京医科大学附属儿童医院新生儿病房收治的临床诊断新生儿惊厥并行VEEG检查的患儿,记录VEEG检查结果及相关临床资料,采用x2检验、Fisher精确概率法或秩和检验进行统计分析.结果 共纳入118例患儿,VEEG异常94例(79.6％),其中轻度异常59例,中度异常21例,重度异常14例;轻度异常以成熟延迟为主,中、重度异常以阵发性异常为主;VEEG重度异常患儿背景活动均为异常(100％),背景异常率高于轻度及中度异常患儿,差异有统计学意义(P＜0.001);背景异常患儿后期癫痫发作率、发育迟缓率均高于背景正常患儿,差异有统计学意义(P＜0.001);VEEG检查时共32例新生儿监测到发作性事件,17例为非癫痫性事件,多见于肌阵挛型发作、微小型发作及对称性强直型发作;15例为癫痫性电-临床、电发作,其中12例为局灶性发作.不同VEEG异常程度患儿后期癫痫发作率及发育迟缓率比较,差异有统计学意义(P＜0.001),且成正相关.结论 新生儿惊厥VEEG异常率较高;非癫痫性事件多见于微小型发作和肌阵挛型发作息儿,癫痫性发作多数为局灶性发作;新生儿VEEG背景对判断患儿远期预后有重要意义;VEEG异常程度越重,后期癫痫发作率及发育迟缓率越高.