Abstract: Objective To investigate the regularity characteristics of brain function of neonates with hypoxic ischaemic encephalopathy(HIE),and to discuss the value of the quantitative indexes in predicting prognosis of HIE. Methods Totally 60 HIE neonates admitted in the neonatal intensive care unit of the Affiliated Hospital of Yan′an University within 6 hours after birth were enrolled in this study,and were divided into mild group,moderate group and severe group according to the diagnostic criteria of HIE.And 20 non-HIE children were selected as control group at the same time.Amplitude integrated electroencephalogram(aEEG) monitoring was performed within six hours after admitted to the hospital,and the duration lasted for 12 hours.The quantitative measures of amplitude,discontinuity,relative delta power(RDP) among four groups were analyzed.The neonates were followed up for three months.The developmental quotient(DQ) was assessed when the infants was three months old.And the correlation between DQ and the quantitative indexes such as amplitude,discontinuity,RDP was analyzed. Results There were significant differences on highest/lowest amplitude,discontinuity,RDP among the four groups(P＜0.05).The control group was not significantly different from mild HIE groupon amplitude,discontinuity and RDP(P＞0.016 7).However,there were significant differences on highest/lowest amplitude,discontinuity and RDP between mild and moderate HIE group,moderate and severe HIE group(P＜0.016 7).The amplitude and RDP decreased from mild HIE group to severe HIE group,while the discontinuity of aEEG signal increased from mild HIE group to severe HIE group.DQ of the children decreased with the increase of HIE severity(P＜0.05).The DQ value was positively correlated with the lowest amplitude(r=0.756,P＜0.05) and RDP(r=0.526,P＜0.05),negatively related to the discontinuity(r=-0.684,P＜0.05).But the correlation between DQ and the highest amplitude was not significant (P＞0.05). Conclusions With the aggravation of HIE,the discontinuity,amplitude and RDP become lower.There is correlative relationship between HIE and DQ at the age of three months old.Moreover,DQ value is positively correlated with the lowest amplitude and RDP,and is negatively related to the discontinuity.The lowest amplitude,discontinuity and RDP are partly associated with prognosis.The quantitative analysis of aEEG can facilitate interpretation in electroencephalogram of HIE neonates,thereby laying foundation to the development of automated neonatal electroencephalogram analysis technique.

Key words: hypoxic ischaemic encephalopathy, amplitude-integrated electroencephalogram, quantitative analysis, developmental quotient, neonates

摘要： 目的 分析缺氧缺血性脑病(HIE)新生儿脑功能的规律特点,探讨其判断预后的价值。方法 选取延安大学附属医院 2014年6月-2017年 1 月出生的 6 h 以内入住新生儿重症监护室的足月HIE新生儿60例,根据 HIE 的诊断标准分为轻度组、中度组和重度组,选取同期非脑损伤患儿20例作为对照组,入院6 h内行多导联的振幅整合脑电图(aEEG)监测,监测时间12 h。对4组患儿aEEG的指标,如振幅、不连续性、相对δ功率(RDP)进行定量分析,随访3月龄(DQ)。比较4组DQ值的差异及4组患儿的振幅、不连续性、相对δ功率与3月龄DQ值的相关性。结果 4组患儿的定量指标最低振幅、最高振幅、不连续性、RDP差异有统计学意义(P<0.05)。组间比较:对照组与轻度组的最低振幅、最高振幅、不连续性、RDP的差异无统计学意义(P>0.016 7);轻度组与中度组、中度至重度组的最高振幅、最低振幅、不连续性、RDP的差异有统计学意义(P<0.016 7)。从轻度组至重度组振幅逐渐降低,不连续性递增,RDP下降。4组患儿3月龄DQ值差异有统计学意义(P<0.05)。3月龄DQ值与最低振幅正相关(r=0.756,P<0.05),与不连续性呈负相关(r=-0.684,P<0.05),与RDP呈正相关(r=0.526,P<0.05),与最高振幅相关性不显著(P>0.05)。结论 随着HIE临床程度的加重,aEEG背景活动的连续性变差,振幅逐渐降低,RDP逐渐降低。HIE程度与3月龄DQ值具有相关性。3月龄DQ值与最低振幅、RDP正相关,与不连续性负相关。最低振幅、连续性、RDP三联指标可在一定程度上预测预后。aEEG的定量分析可简化HIE新生儿脑电图的阅图难度,为产生一种客观的自动化脑电图分析方法奠定基础。

关键词: 缺氧缺血性脑病, 振幅整合脑电图, 定量分析, 发育商, 新生儿