脑功能联合血乳酸监测预测窒息新生儿神经发育行为异常的价值

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摘要目的探讨脑功能联合血乳酸监测预测窒息新生儿神经发育行为异常的价值。方法将我院新生儿科2017年1月～2018年6月接收的69例窒息新生儿（Apgar评分≤7分）作为研究对象，留取出生后1 h的外周动脉血检测乳酸（LA）水平；均于出生后6 h及3 d行新生儿振幅整合脑电图（aEEG）监测，采用盖泽尔发育量表（Gesell）评估患儿3个月时的神经发育行为水平；统计出生后6 h、3 d新生儿不同aEEG分度下的神经发育行为情况，不同LA分度下的神经发育行为情况，统计aEEG、LA及aEEG联合LA预测神经发育行为异常的效能。结果LA＜2.66 mmol/L组窒息新生儿的神经发育行为情况显著优于LA＞4.50 mmol/L组，差异有统计学意义（P＜0.05）；出生后6 h，aEEG正常组及轻度异常组窒息新生儿神经发育行为显著优于重度异常组，差异有统计学意义（P＜0.05）；出生后3 d，aEEG正常组窒息新生儿神经发育行为显著优于轻度异常组及重度异常组，差异有统计学意义（P＜0.05）。出生后6 h aEEG+LA预测窒息新生儿神经发育行为异常敏感度最高，为95.45%，出生3 d aEEG+LA预测窒息新生儿的神经发育行为异常Youden指数最高，为0.6538。结论 aEEG、LA可反映窒息新生儿的早期神经发育行为异常，生后6 h，aEEG+LA预测窒息新生儿的神经发育行为异常敏感度最高，出生3 d，aEEG+LA的预测效能最佳。

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	谭丽芬
	郭小芳
	袁淑燕

关键词 ：振幅整合脑电图, 乳酸, 窒息新生儿, 神经发育行为

Abstract：Objective To explore the the value of brain function monitoring combined blood lactate in predicting abnormal neurodevelopmental behavior in neonates with asphyxia.Methods A total of 69 cases of asphyxia neonates(Apgar score≤7 points)received from January 2017 to June 2018 treated in our hospital were included in this study.The lactic acid (LA)level was measured in peripheral arterial blood 1 hour after birth.Neonatal amplitude integrated electroencephalogram(aEEG)was monitored at the 6thhour and the 3rdday after birth,and the neurodevelopmental behavior at the 3rdmonth was assessed by Geiser′s Developmental Scale (Gesell).The neurodevelopmental behaviors under different aEEG indexings at 6thhour and the 3rdday were compared.The neurodevelopmental behaviors under different LA indexes were analyzed.The efficacy of aEEG,LA and aEEG combined with LA in the diagnosis of neurodevelopmental abnormalities were evaluated.Results The neurodevelopmental behavior in neonates with asphyxia of LA＜2.66 mmol/L group was significantly better than that of LA＞4.50 mmol/L group,the difference was statistically significant(P＜0.05).The neurodevelopmental behavior of neonates with asphyxia of the aEEG normal group and mild abnormal group were significantly better than that of severe group,the differences were statistically significant(P＜0.05)；the neurodevelopmental behavior of neonates with asphyxia of the aEEG normal group was significantly better than that of the mild abnormal group and severe abnormal group,the differences were statistically significant(P＜0.05).The highest sensitivity of aEEG+LA predicts at the 6thhour after birth was 95.35%of neurodevelopmental behavior in neonates with asphyxia.The aEEG+LA predicts at the 3rdday the neonatal developmental abnormality of neonatal developmental disorder was the highest,which was 0.6538.Conclusion aEEG and LA can respond to early neurodevelopmental behavior abnormalities in neonates with asphyxia.The 6thhour after birth,AEEG+LA predicts the highest neurodevelopmental abnormality in neonates with asphyxia.The predicted efficacy of the 3rdday aEEG+LA is the best.

Key words： Amplitude integrated electroencephalogram Lactic acid Asphyxia neonates Neurodevelopmental behavior

基金资助:广东省江门市卫生计生局科学技术研究项目（18 A045）

作者简介: 谭丽芬（1983-），女，广东江门人，本科，主治医师，研究方向：儿童神经发育监护及早期干预

引用本文:

谭丽芬；郭小芳；袁淑燕. 脑功能联合血乳酸监测预测窒息新生儿神经发育行为异常的价值[J]. 中国当代医药, 2019, 26(8): 14-17.
TAN Li-fen; GUO Xiao-fang; YUAN Shu-yan. Value of brain function monitoring combined blood lactate in predicting abnormal neurodevelopmental behavior in neonates with asphyxia. 中国当代医药, 2019, 26(8): 14-17.

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http://dangdaiyiyao.com/CN/ 或 http://dangdaiyiyao.com/CN/Y2019/V26/I8/14

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