早产儿脑白质损伤程度与早期脑电生理变化关系的研究

Relationship between degree of white matter damage and EEG changes in premature infants early after birth

摘要:

目的：通过振幅整合脑电图（amplitude-integrated EEG, aEEG）及原始脑电抑制性电活动持续时间的研究，探讨早产儿脑白质损伤程度与早期脑功能变化的关系。方法：38例小于32周的脑白质损伤早产儿（轻度脑白质损伤20 例，重度脑白质损伤18例）及42 例无脑白质损伤的早产儿纳入研究。自生后开始每周进行一次aEEG监测和颅脑超声检查，直至生后4周或矫正胎龄32周。比较各组aEEG图形及振幅变化趋势及原始脑电爆发抑制比的变化。结果：脑白质损伤组和对照组aEEG均呈高度不连续图形，无成熟的睡眠周期。重度脑白质损伤组下边界振幅明显低于轻度脑白质损伤组和对照组。脑白质损伤组和对照组的原始脑电图形均为爆发性电活动-抑制性电活动交替出现，重度脑白质损伤组抑制段时间及爆发抑制比明显大于轻度脑白质损伤组及对照组。结论：脑白质损伤早产儿早期动态进行脑功能监测有助于早期发现严重脑白质损伤。

Abstract:

OBJECTIVE: To study the relationship between the degree of white matter damage and changes in brain function in premature infants early after birth according to amplitude-integrated electroencephalogram (aEEG) and raw EEG (with burst-suppression patterns). METHODS: Thirty-eight premature infants of less than 32 weeks′ gestational age and with white matter damage, including 20 cases of mild white matter damage and 18 cases of severe white matter damage, were included in the study. Forty-two premature infants without white matter damage were selected as a control group. After birth, they were examined using aEEG and brain ultrasound once a week until four weeks after birth or a corrected gestational age of 32 weeks. The white matter damage and control groups were compared in terms of aEEG patterns and amplitudes and burst suppression ratio (BSR) on EEG. RESULTS: The white matter damage and control groups had highly discontinuous patterns and had no complete sleep cycles. The lower amplitude was significantly smaller in the severe white matter damage subgroup than in the mild white matter damage subgroup and control group. There was alternating burst-suppression activity on the raw EEG in the white matter damage and control groups; and the severe white matter damage subgroup had a significantly longer suppression time and a significantly higher BSR on EEG compared with the mild white matter damage subgroup and control group. CONCLUSIONS: Brain function monitoring should be performed in premature infants with white matter damage early after birth so as to detect cases of severe white matter damage in time.