摘要
目的观察并探讨持续性脑功能监测应用于缺氧缺血性脑病新生儿早期诊断及预后评估中的临床效果。方法选取2015年5月-2018年6月在深圳市龙华区人民医院接受治疗的55例缺氧缺血性脑病(HIE)新生儿作为研究对象。根据临床表现分为轻度、中度和重度3个亚组,并在出生1周后病情稳定时对所有患儿行头颅核磁共振(MRI)检查,根据结果分为轻度、中度、重度3个亚组,同时所有患儿在出生后6 h内接受持续性脑功能监测,根据结果分为无异常、轻度异常、重度异常3个亚组。将患儿的持续性脑功能监测结果分别与临床表现严重程度与出生1周后MRI异常程度进行相关性分析;在随访过程中,利用新生儿行为神经系统(NBNA)评分对患儿出生后1周、2周、4周的状况进行综合性评估,利用中国儿童发展量表(CDCC)在患儿出生后12个月对其发育预后进行评估。结果55例缺氧缺血性脑病(HIE)新生儿中,根据临床表现分组:轻度30例(54.55%),中度17例(30.91%),重度8例(14.55%);根据出生1周后头颅核磁共振(MRI)检查结果分组:轻度32例(58.18%),中度13例(23.64%),重度10例(18.18%);根据持续性脑功能监测结果分组:无异常29例(52.73%),轻度异常14例(25.45%),重度异常12例(21.82%)。相关性分析显示,持续性脑功能监测与临床表现严重程度(r=0.9434,P<0.01)以及MRI异常程度(r=0.9753,P<0.01)均有显著相关性;随访过程中持续性脑功能监测出现重度异常的患儿NBNA评分在各时间点均明显低于仅出现轻度异常的患儿,差异具有统计学意义(P<0.05);持续性脑功能监测出现重度异常的患儿在出生后12个月时CDCC量表中运动发育指数(PDI)及智力发育指数(MDI)均明显低于仅出现轻度异常的患儿,差异具有统计学意义(P<0.05)。结论持续性脑功能监测应用于缺氧缺血性脑病新生儿中能够早期判断其病情严重程度,并且能够有效地预测患儿出院后的神经及行为的发育水平,能够为实施早期有效的临床干预提供可靠依据,值得推广应用。
Objective To explore the clinical effect of continuous brain function monitoring in early diagnosis and prognosis evaluation of neonates with hypoxic-ischemic encephalopathy.Methods A total of 55 neonates with hypoxicischemic encephalopathy(HIE)who were treated in the hospital from May 2015 to June 2018 were selected as subjects.According to the clinical manifestations,they were divided into mild,moderate and severe groups.And all the children were examined by MRI 1 week after birth,according to the results,they were divided into mild,moderate and severe groups.Meanwhile,all the children were monitored brain function continuously within 6 hours after birth.According to the results,they were divided into groups of no abnormality,mild abnormality and severe abnormality.The correlation between the monitoring results of persistent brain function and the severity of clinical manifestations and the abnormal degree of MRI was analyzed.During the follow-up,the neonatal behavioral nervous system(NBNA)score was evaluated the status after birth.The developmental prognosis of the children was evaluated by China Child Development scale(CDCC)at 12 months after birth.Results Among 55 neonates with hypoxic-ischemic encephalopathy(HIE),30 cases were mild(54.55%),17 cases were moderate(30.91%)and 8 cases were severe(14.55%).According to the results of cranial MRI(MRI),32 cases(58.18%)were mild,13 cases(23.64%)were moderate and 10 cases(18.18%)were severe.According to the results of continuous brain function monitoring,there were no abnormalities of 29 cases(52.73%),mild abnormalities of 14 cases(25.45%)and severe abnormalities of 12 cases(21.82%).Correlation analysis showed that continuous cerebral function monitoring was significantly correlated with the severity of clinical manifestations(r=0.9434,P<0.01)and the abnormal degree of MRI(0.9753,P<0.01).During the follow-up,the NBNA score of children with severe abnormality in continuous cerebral function monitoring was significantly lower than that of children with only mild abnormality(P<0.05).The motor development index(PDI)and intelligence development index(MDI)of CDCC scale in the children with severe abnormalities were significantly lower than those with only mild abnormalities at 12 months after birth.The difference was statistically significant(P<0.05).Conclusion The application of continuous brain function monitoring in neonates with hypoxic-ischemic encephalopathy can early judge the severity of hypoxic-ischemic encephalopathy and effectively predict the development level of nerve and behavior after discharge.It can provide a reliable basis for the implementation of early and effective clinical intervention,and is worth popularizing and applying.
作者
吴齐爱
陈明秋
韦婷艳
朱东波
WU Qiai;CHEN Mingqiu;WEI Tingyan;ZHU Dongbo(Department of Neonatology,Longhua District People's Hospital,Guangdong Shenzhen 518109,China)
出处
《新疆医科大学学报》
CAS
2020年第12期1604-1608,共5页
Journal of Xinjiang Medical University
基金
深圳市龙华区科技创新资金项目(2017068)。
关键词
持续性脑功能监测
缺氧缺血性脑病
新生儿
早期诊断
预后
continuous cerebral function monitoring
hypoxic-ischemic encephalopathy
newborn
early diagnosis
prognosis
