振幅整合脑电图监测在缺氧缺血性脑病诊断及亚低温治疗效果评价的临床研究

摘要

目的：研究振幅整合脑电图(amplitude-integrated electroencephalogram,aEEG)监测在缺氧缺血性脑病(hypoxic ischemic encephalopathy,HIE)诊断的价值及亚低温治疗 HIE 时 aEEG 的变化,评价亚低温治疗效果。方法连续监测亚低温治疗前后 aEEG 的变化,分析 aEEG 各种波形出现的比例。结果共90例患儿纳入研究,其中 aEEG 正常43例；轻度异常33例,重度异常14例。aEEG 监测结果与 HIE 临床分度及头颅 MRI 检查结果具有较高的一致性(Kappa ﹦0.584,P 〈0.001；Kappa ﹦0.590,P 〈0.001)。aEEG 对预测 HIE 轻重程度的敏感性、特异性、阳性预测值、阴性预测值均较高。轻度及重度异常 aEEG 亚低温治疗前后差异有统计学意义(P 〈0.05)。结论 aEEG 对 HIE 的早期诊断及轻重程度判断具有较优的评价效果。亚低温可明显降低 HIE 后异常 aEEG 出现的比例,具有神经保护作用,对轻中度 HIE 治疗效果明显。%Objective To evaluate the values of amplitude-integrated electroencephalogram(aEEG) on the diagnosis of hypoxic ischemic encephalopathy(HIE),and the changes of aEEG in HIE with hypother-mia treatment.And to assess the therapeutic effect of hypothermia.Methods The changes of aEEG were continuously monitored before and after hypothermia treatment,and the proportions of various waveforms ap-pearing in aEEG were analyzed.Results A total of 90 cases were enrolled in this study,the changes of aEEG were monitored,including aEEG normal in 43 cases,mild abnormalities in 33 cases and severe abnor-malities in 14 cases.aEEG monitoring had a higher consistency with HIE grade and cranial MRI examination (Kappa ﹦0.584,P 〈0.001 ;Kappa ﹦0.590,P 〈0.001 ).The sensitivity,specificity,positive predictive val-ue,and negative predictive values of aEEG were high in predicting the severity of HIE.The index of with mild and severe abnormalities of aEEG was significant difference before and after the treatment of hypother-mia(P 〈0.05).Conclusion aEEG has a better evaluation effect on early diagnosis and severity assessing of HIE.Hypothermia can significantly reduce the proportion of abnormal aEEG after HIE,have a neuroprotective effect on the treatment of mild to moderate HIE.