Evaluation of regional cerebral oxygen saturation combined with amplitude integrated electroencephalogram in neonates with hypoxic-ischemic encephalopathy
TAN Ruokun, HOU Zhanghua, CHEN Lijuan, LI Ya
Department of NICU, Chenzhou NO.1 People's Hospital, Chenzhou 423000, China
摘要目的: 探讨新生儿缺氧缺血性脑病（HIE）患儿的局部脑组织氧饱和度（rSO2）联合振幅整合脑电图（aEEG）的变化及对新生儿HIE预后的评估价值。方法: 采用前瞻性研究,收集2018年7月—2021年7月郴州市第一人民医院新生儿科及NICU收治住院的HIE患儿资料,分析患儿生后6、12、24、72 h 4个节点检测的rSO2以及动态监测的aEEG结果。多因素Logistic 回归分析生后6、12、24、72 h 4个节点检测的rSO2以及动态监测aEEG 5个变量以及应用诊断的曲线下面积并进行ROC曲线分析。结果: 共63例HIE患儿纳入实验组,轻度HIE30例（47.6%）,中度HIE 23例（36.5%）,重度HIE 10例（15.9%）。轻、中度HIE组患儿生后6、12 h及重度HIE组患儿各时间节点rSO2均低于正常对照组;中、重度HIE组患儿的rSO2低于轻度HIE组患儿;重度HIE组低于中度HIE组。出生后6 、24 h rSO2水平,aEEG监测及三者联合应用诊断的曲线下面积分别为0.891、0.843、0.705、0.950,在最佳的临界点,对应的敏感度（特异性）分别为0.926（0.822）、0.926（0.989）、0.667（0.700）、0.960（0.925）;ROC曲线显示三者联合应用所得的曲线下面积最大,其诊断敏感性联合特异性的综合评价优于单一监测方法。结论: 在不同程度的HIE下,当rSO2过低出现了脑功能的异常时,脑损伤的程度可能会更重。生后6 h rSO2、生后24 h rSO2、aEEG方法在评价HIE的严重程度发挥重要的作用,三者联合评价HIE更能提高诊断的准确性。
Abstract：Objective To investigate the changes of regional oxygen saturation (rSO2) and amplitude integrated electroencephalogram (aEEG) in neonates with hypoxic-ischemic encephalopathy (HIE) and their prognostic value. Methods Using prospective research, Collect data on HIE patients admitted to the Department of Neonatology and NICU of Chenzhou First People's Hospital from July 2018 to July 2021. Analyze the rSO2 detection and dynamic monitoring of aEEG results at 4 nodes of the pediatric patients at 6h, 12h, 24h, and 72h after birth. Conduct multivariate logistic regression analysis on the rSO2 detected at 4 nodes at 6h, 12h, 24h, and 72h after birth and the aEEG 5 variables dynamically monitored, and area under the diagnostic curve and perform ROC curve analysis. Results A total of 63 neonates with HIEs were included in the experimental group, including 30 mild HIEs (47.6%), 23 moderate HIEs (36.5%), and 10 severe HIEs (15.9%). The rSO2 levels at various time points in the mild to moderate HIE group were lower than those in the normal control group at 6h, 12h after birth, and in the severe HIE group; The rSO2 levels in children with moderate to severe HIE were lower than those in children with mild HIE; The severe HIE group was lower than the moderate HIE group. The area under the curve for rSO2 levels at 6 hours after birth, rSO2 levels at 24 hours after birth, aEEG monitoring, and their combined diagnosis were 0.891, 0.843, 0.705, and 0.950, respectively. At the optimal critical point, the corresponding sensitivity (specificity) were 0.926(0.822), 0.926(0.989), 0.667(0.700), and 0.960(0.925), respectively; The Receiver operating characteristic shows that the area under the curve obtained by the combined application of the three methods is the largest, and the comprehensive evaluation of its diagnostic sensitivity and specificity is better than that of a single monitoring method. Conclusion Under different degrees of HIE, when rSO2 is too low and abnormal brain function occurs, the degree of brain injury may be more severe. The methods of rSO2 at 6 hours after birth, rSO2 at 24 hours after birth, and aEEG play an important role in evaluating the severity of HIE, and the combined evaluation of the three can improve the accuracy of diagnosis.
2023, Vol. 20 
