本文選題：足月兒 + 神經(jīng)行為評(píng)分�。� 參考：《延安大學(xué)》2017年碩士論文

【摘要】：目的探討早期不同臨床分度的新生兒缺氧缺血性腦病(hypoxic-ischemic encephalopathy,HIE)腦電生理特點(diǎn)及早期腦功能監(jiān)測(cè)在診斷HIE、評(píng)估神經(jīng)系統(tǒng)預(yù)后中的作用,為臨床早期診斷缺氧缺血性腦病提供理論依據(jù)。方法選取延安大學(xué)附屬醫(yī)院2014年12月至2016年11月出生的6小時(shí)以內(nèi)入院臨床診斷為HIE的患兒58例,根據(jù)臨床表現(xiàn)分為輕度、中度、重度,選取同期非腦損傷足月兒21例作為對(duì)照組,在入院后6小時(shí)內(nèi)進(jìn)行振幅整合腦電圖(amplitudeintegrated electroencephalogram,aEEG)監(jiān)測(cè),持續(xù)監(jiān)測(cè)20-24小時(shí)。所有患兒在生后3-7天進(jìn)行頭顱磁共振檢查(magnetic resonance imaging,MRI);并在出生3天、2周、4周對(duì)所有患兒進(jìn)行神經(jīng)行為(Neonatal Behavioral Neurological Assessment,NBNA)評(píng)分。分析各組患兒背景波最高、最低電壓、睡眠覺醒周期(sleep-wake circle,SWC)、背景活動(dòng)等腦功能的電生理特點(diǎn);aEEG分類結(jié)果、頭顱MRI分度與HIE臨床分度之間的關(guān)系;HIE臨床分度、aEEG分類結(jié)果與NBNA評(píng)分之間的關(guān)系。結(jié)果1.四組患兒最高電壓均值的差異明顯,有統(tǒng)計(jì)學(xué)意義(P0.05);其中,對(duì)照組與輕度HIE組最高電壓均值的差異不明顯,無統(tǒng)計(jì)學(xué)意義(P0.0125);其余各組間最高電壓均值的差異明顯,有統(tǒng)計(jì)學(xué)意義(P0.0125)。2.四組患兒最低電壓均值的差異明顯,具有統(tǒng)計(jì)學(xué)意義(P0.05);其中,對(duì)照組與輕度HIE組最低電壓均值的差異不明顯,無統(tǒng)計(jì)學(xué)意義(P0.0125);其余各組間最低電壓均值的差異明顯,有統(tǒng)計(jì)學(xué)意義(P0.0125)。3.四組患兒SWC總體分布的差異明顯,有統(tǒng)計(jì)學(xué)意義(P0.05);其中,對(duì)照組與輕度HIE組SWC分布的差異不明顯,無統(tǒng)計(jì)學(xué)意義(P0.0083);其余各組間SWC分布的差異明顯,有統(tǒng)計(jì)學(xué)意義(P0.0083);用speraman等級(jí)相關(guān)分析,相關(guān)系數(shù)為0.861,P0.001。4.四組患兒背景活動(dòng)的總體分布差異明顯,有統(tǒng)計(jì)學(xué)意義(P0.05);其中,對(duì)照組與輕度HIE組背景活動(dòng)分布的差異不明顯,無統(tǒng)計(jì)學(xué)意義(P0.0083);其余各組間背景活動(dòng)的分布差異明顯,有統(tǒng)計(jì)學(xué)意義(P0.0083);用speraman等級(jí)相關(guān)分析,相關(guān)系數(shù)為0.855,P0.001。5.四組患兒aEEG分類結(jié)果總體分布的差異明顯,有統(tǒng)計(jì)學(xué)意義(P0.05);其中,對(duì)照組與輕度HIE組aEEG分類結(jié)果差異不明顯,無統(tǒng)計(jì)學(xué)意義(P0.0083);其余各組間aEEG分類結(jié)果分布差異明顯,有統(tǒng)計(jì)學(xué)意義(P0.0083);用speraman等級(jí)相關(guān)分析,相關(guān)系數(shù)為0.745,P0.001。6.四組患兒頭顱MRI分度的總體分布的差異明顯,有統(tǒng)計(jì)學(xué)意義(P0.05);任意兩組間頭顱MRI分度的分布差異明顯,有統(tǒng)計(jì)學(xué)意義(P0.0083);用speraman等級(jí)相關(guān)分析,相關(guān)系數(shù)為0.937,P0.001。7.不同aEEG結(jié)果患兒頭顱MRI分度的總體分布的差異明顯,有統(tǒng)計(jì)學(xué)意義(P0.05);任意兩組間頭顱MRI分度的分布差異均明顯,有統(tǒng)計(jì)學(xué)意義(P0.017);用speraman等級(jí)相關(guān)分析,相關(guān)系數(shù)為0.948,P0.001。8.四組患兒3天、2周、4周NBNA評(píng)分的均值差異明顯,有統(tǒng)計(jì)學(xué)意義(P0.05);任意兩組在3天、2周、4周NBNA評(píng)分的均值差異明顯,有統(tǒng)計(jì)學(xué)意義(P0.0125)。9.不同aEEG結(jié)果的患兒在3天、2周、4周時(shí)NBNA評(píng)分的均值差異明顯,有統(tǒng)計(jì)學(xué)意義(P0.05);任意兩組間患兒在3天、2周、4周NBNA評(píng)分的均值差異均明顯,有統(tǒng)計(jì)學(xué)意義(P0.017)。結(jié)論1.隨著HIE臨床程度的加重,最高電壓逐漸上升,最低電壓逐漸下降;HIE臨床分度愈重,電壓上升或者下降的幅度愈明顯。2.SWC、背景活動(dòng)與HIE臨床分度一致性良好,具有密切的相關(guān)性。3.aEEG分類結(jié)果、頭顱MRI分度與HIE臨床分度任意兩者之間一致性良好,具有密切的相關(guān)性。4.aEEG可以更早、更及時(shí)發(fā)現(xiàn)腦功能異常,有助于臨床早期協(xié)助診斷HIE,可以作為HIE早期的診斷指標(biāo)。5.頭顱MRI分度與HIE臨床分度一致,但是aEEG的時(shí)效性、便利性均優(yōu)于頭顱MRI。6.不同程度HIE患兒神經(jīng)行為發(fā)育不同,輕度HIE組較中重度HIE組患兒的神經(jīng)系統(tǒng)功能恢復(fù)較快,值得臨床繼續(xù)進(jìn)行HIE臨床分度與神經(jīng)系統(tǒng)遠(yuǎn)期發(fā)育進(jìn)行深入研究。7.aEEG分類結(jié)果不同,患兒在新生兒期不同年齡的神經(jīng)行為發(fā)育不同。aEEG結(jié)果正常組的患兒較aEEG結(jié)果輕度異常組和重度異常組患兒的神經(jīng)系統(tǒng)功能恢復(fù)快,值得臨床繼續(xù)進(jìn)行不同aEEG結(jié)果與神經(jīng)系統(tǒng)遠(yuǎn)期發(fā)育進(jìn)行深入研究。
[Abstract]:Objective to investigate the electrophysiological characteristics of hypoxic-ischemic encephalopathy (HIE) and early brain function monitoring in the diagnosis of HIE and evaluate the prognosis of the nervous system in early diagnosis of neonatal hypoxic ischemic encephalopathy (HIE), and to provide a theoretical basis for the early diagnosis of hypoxic ischemic encephalopathy. Method selected Affiliated Hospital of Yan'an University, 2014 In the 6 hours from December to November 2016, 58 children diagnosed with HIE were admitted to hospital. According to their clinical manifestations, they were divided into mild, moderate and severe. 21 cases of non brain injury in the same period were selected as the control group. The amplitude integrated electroencephalogram (amplitudeintegrated electroencephalogram, aEEG) monitoring and continuous monitoring 2 within 6 hours after admission were carried out. 0-24 hours. All children underwent magnetic resonance imaging (MRI) at 3-7 days after birth; and all children were scored at 3, 2, and 4 weeks of birth (Neonatal Behavioral Neurological Assessment, NBNA). The highest, lowest voltage, and sleep awakening cycle (sleep-wake circle, S) were analyzed. WC), the electrophysiological characteristics of the brain function such as background activity, aEEG classification results, the relationship between the head MRI score and the clinical score of HIE; the relationship between the HIE clinical score, the aEEG classification result and the NBNA score. Results 1. the difference of the mean value of the highest voltage in the four groups was significant (P0.05); among them, the highest voltage of the control group and the mild HIE group The difference of mean value was not significant (P0.0125), and the difference of the average value of the highest voltage between the other groups was obvious. The difference of the mean value of the minimum voltage in the four groups of.2. groups was statistically significant (P0.05), and the difference of the mean value of the minimum voltage in the control group and the light HIE group was not significant (P0.01). 25): the difference of the mean value of the lowest voltage between the other groups was obvious, and there was significant difference in the overall distribution of SWC in the children of.3. four groups (P0.0125), and there was statistical significance (P0.05), and there was no significant difference in the distribution of SWC between the control group and the mild HIE group (P0.0083), and the difference of SWC distribution among the other groups was significant (P). 0.0083); with speraman grade correlation analysis, the correlation coefficient was 0.861, and the overall distribution of background activities in the group P0.001.4. four was significant (P0.05), and there was no significant difference in the distribution of background activity between the control group and the mild HIE group (P0.0083); the distribution of background activities in the other groups was distinct, and there was a significant difference between the other groups. Study significance (P0.0083); with speraman grade correlation analysis, the correlation coefficient was 0.855, and the overall distribution of aEEG classification results in P0.001.5. four groups was significant (P0.05). The difference of aEEG classification results between the control group and the mild HIE group was not obvious, no statistical significance (P0.0083), and the distribution difference of the aEEG classification between the other groups was different. Obviously, there was statistical significance (P0.0083); the correlation coefficient was 0.745 with speraman level correlation analysis, and the total distribution of head MRI diversity in group P0.001.6. four was significant (P0.05); the distribution difference between two groups of two groups was significant, statistically significant (P0.0083); correlation analysis of speraman grade, correlation line The total distribution of head MRI diversity in children with different aEEG results was 0.937, with significant difference (P0.05), and the difference in the distribution of head MRI scores between any two groups was significant (P0.017); the correlation coefficient was 0.948 with speraman grade correlation analysis, 3 days in group P0.001.8. four, 2 weeks and 4 weeks in NBNA scores. The value difference was significant (P0.05); the mean difference in the mean value of NBNA scores in any two groups at 3, 2, and 4 weeks was significant. The mean difference in the mean value of NBNA scores at 3, 2, and 4 weeks in children with different aEEG results was statistically significant (P0.05); the mean difference in NBNA scores at 3 days, 2 weeks, and 4 weeks in any of the two groups of children was different. It was statistically significant (P0.017). Conclusion 1. with the aggravation of HIE, the maximum voltage increased gradually and the minimum voltage decreased gradually. The more the HIE clinical score was, the more obvious the amplitude of the voltage or the decrease of the voltage was.2.SWC, the background activity was in good agreement with the HIE clinical diversity, with a close correlation of the.3.aEEG classification results and the MRI score of the head. There is a good consistency between the degree and the HIE clinical diversity, with a close correlation,.4.aEEG can be earlier, more timely detection of abnormal brain function, help the early diagnosis of HIE, and can be used as a diagnostic indicator of the early HIE,.5. head MRI degree is consistent with the HIE clinical diversity, but aEEG's aging and convenience are better than the skull MRI.6.. The neurobehavioral development of children with HIE in different degrees is different. The nervous system function of the mild HIE group is faster than that of the moderate severe HIE group. It is worth to continue to carry on the clinical division of the HIE and the long-term development of the nervous system. The results of the.7.aEEG classification are different. The neurobehavioral development of the children at different ages of the newborn is different from the.AEEG results. The neurological function of the children in the normal group was faster than that in the mild abnormal group and the severe abnormal group of the aEEG. It is worth to carry on the further study of the different aEEG results and the long-term development of the nervous system.
【學(xué)位授予單位】：延安大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R742

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本文編號(hào)：2020805