振幅整合脑电图联合血乳酸、乳酸清除率在新生儿窒息病情和预后评估中的价值-现代医学

振幅整合脑电图联合血乳酸、乳酸清除率在新生儿窒息病情和预后评估中的价值

单位：会理市人民医院儿科, 四川会理 615100

分类号：R722.12

出版年·卷·期（页码）：2022·50·第一期（95-100）

摘要：

目的：探讨振幅整合脑电图(aEEG)联合血乳酸(LAC)、乳酸清除率(LCR)在新生儿窒息病情和预后评估中的价值。方法：回顾性收集2016年12月至2020年12月本院收治的71例窒息新生儿的临床资料。根据1 min Apgar评分分为轻度窒息组32例和重度窒息组39例；根据预后情况分为存活组61例和死亡组10例。记录一般资料、aEEG异常率，入院时及治疗6 h后LAC水平及6 h LCR。记录不同aEEG分度与窒息新生儿病情及预后的关系。利用受试者工作特征(ROC)曲线及曲线下面积(AUC)分析aEEG及LAC、LCR对窒息新生儿病情和预后的预测价值。结果：重度窒息组血pH值、6 h LCR均低于轻度窒息组。重度窒息组aEEG异常率、入院及6 h LAC水平均高于轻度窒息组(P<0.05)；死亡组血pH值、6 h LCR均低于存活组。死亡组aEEG异常率、入院及6 h LAC水平均高于存活组(P<0.05)；轻度窒息组aEEG情况优于重度窒息组，存活组aEEG情况优于死亡组(P<0.05)；aEEG、LAC、LCR预测窒息新生儿病情的AUC分别为0.682、0.727、0.767,三者联合预测窒息新生儿病情的AUC为0.834；aEEG、LAC、LCR预测窒息新生儿预后的AUC分别为0.815、0.826、0.831，三者联合预测窒息新生儿预后的AUC为0.911。结论：aEEG联合LAC、LCR对新生儿窒息病情和预后评估具有积极意义，值得临床推广应用。

Objective:To explore the value of amplitude integrated electroencephalogram(aEEG) combined with blood lactate(LAC), lactate clearance rate(LCR) in evaluating the condition and prognosis of neonatal asphyxia.Methods:The clinical data of 71 asphyxiated neonates admitted to our hospital from December 2016 to December 2020 were retrospectively collected. According to the 1min Apgar score, all asphyxiated neonates were divided into mild asphyxia group(n=32) and severe asphyxia group(n=39); According to prognosis, all asphyxiated neonates were divided into survival group(n=61) and death group(n=10). General data of asphyxiated neonates were recorded, and the abnormal rate of aEEG was recorded. LAC level of asphyxiated neonates was measured at admission and 6 h after treatment. The LCR was calculated at 6 h after treatment. The relationship between different aEEG scale and the condition and prognosis of asphyxia neonates was recorded. The receiver operating characteristic curve(ROC) was used to analyze the predictive value of aEEG and LAC, LCR on the condition and prognosis of asphyxia neonates.Results:The pH value and 6 h LCR in the severe asphyxia group were lower than those in the mild asphyxia group; the aEEG abnormality rate, blood lactic acid admission and 6 h LAC levels in the severe asphyxia group were higher than those in the mild asphyxia group(P<0.05). The pH value and 6 h LCR of the death group were lower than those of the survival group; the aEEG abnormality rate, LAC admission and 6 h LAC level of the death group were higher than those of the survival group(P<0.05). The aEEG status of the mild asphyxia group was better than that of the severe asphyxia group, and the aEEG status of the survival group was better than that of the death group(P<0.05). TheAUC for predicting the condition of neonatal asphyxia with aEEG, LAC, LCR were 0.682, 0.727 and 0.767 respectively, the AUC for predicting the condition of neonatal asphyxia with aEEG combined with LAC, LCR was 0.834. The AUC for predicting the prognosis of neonatalasphyxia with aEEG, LAC, LCR were 0.815, 0.826 and0.831 respectively, the AUC for predicting the prognosis of neonatal asphyxia with aEEG combined with LAC, LCR was 0.911. Conclusion:aEEG combined with LAC, LCR has a positive significance in the evaluation of the condition and prognosis of neonatal asphyxia, which is worthy of clinical application.

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