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缺血缺氧性脑病(HIE)常见于新生儿,其致病原因主要与围生期窒息有关[1]。该病是因脑血流灌注不足和低血氧引起的脑组织慢性损害,易造成患儿意识障碍、嗜睡、反应迟钝、昏迷等症状,严重时可造成死亡[2]。有效提高HIE患儿的早期诊断,降低患儿眼部及脑部后遗症的发生具有重要意义。视诱发电位(VEP)检测主要包括闪光诱发电位(F-VEP)和图形诱发电位(P-VEP)[3]。研究人员[4]指出,VEP对HIE患儿视觉及神经系统功能具有重要评估作用。另有资料[5]显示,VEP也可应用于治疗过程中患儿神经系统后遗症的检测。但目前有关VEP检测在HIE患儿中的临床应用研究较少,新生儿的VEP标准仍为空白。本研究探讨VEP在HIE患儿视功能检查中的应用,以期为临床早期干预提供参考。现作报道。
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HIE各组患儿F-VEP和P-VEP振幅均明显低于对照组(P<0.01),且随着患儿HIE病情程度增加而降低(P<0.01);HIE各组患儿潜伏期均高于对照组(P<0.01),且随着患儿病情程度增加而增加(P<0.01)(见表 1)。
分组 n F-VEP振幅/V F-VEP潜伏期/ms P-VEP振幅/V P-VEP潜伏期/ms 对照组 30 10.20±2.53 116.14±5.95 10.80±2.17 103.99±6.3 HIE轻度组 37 8.67±1.43** 132.98±9.73** 7.53±1.48** 122.40±8.75** HIE中度组 38 5.36±1.20**△△ 160.08±11.18**△△ 5.01±0.95**△△ 134.13±9.30**△△ HIE重度组 25 2.79±0.92**△△## 198.31±12.41**△△## 2.66±0.73**△△## 176.62±11.34**△△## F — 120.505 353.29 168.029 316.813 P — <0.01 <0.01 <0.01 <0.01 MS组内 — 2.642 101.237 2.076 80.902 q检验:与对照组比较**P<0.01;与HIE轻度组比较△△P<0.01;与HIE中度组比较##P<0.01 表 1 各组VEP参数比较(x±s)
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各组HIE患儿斜视、眼球震颤、视神经萎缩发生率和眼部病变总发生率差异均有统计学意义(P<0.05~P<0.01)(见表 2)。
分组 n 斜视 眼球震颤 视神经萎缩 总发生率 HIE轻度组 37 2(5.41) 2(5.41) 4(10.81) 8(21.62) HIE中度组 38 5(13.16) 4(10.53) 8(21.53) 17(44.74) HIE重度组 25 7(28.00) 6(24.00) 9(36.00) 22(88.00) χ2 — 6.36 5.01 5.71 26.52 P — <0.05 <0.05 <0.05 <0.01 表 2 各组HIE患儿眼部病变情况比较[n;百分率(%)]
缺血缺氧性脑病患儿视觉发育障碍的早期视诱发电位评估
Early evaluation of visual evoked potential in hypoxic ischemic encephalopathy children with visual developmental disorders
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摘要:
目的探讨早期视诱发电位(VEP)检测对缺氧缺血性脑病(HIE)患儿的临床价值。 方法选取HIE患儿100例为研究对象,依据HIE临床分度标准分为HIE轻度组37例、中度组38例和重度组25例;另选取同期健康幼儿30名为对照组。比较各组闪光诱发电位(F-VEP)和图形诱发电位(P-VEP)的潜伏期和波幅,并比较HIE各组患儿斜视、眼球振颤、视神经萎缩等眼部功能异常的发生率。 结果HIE各组患儿F-VEP和P-VEP振幅均明显低于对照组(P<0.01),且随着患儿HIE病情程度增加而降低(P<0.01);HIE各组患儿潜伏期均高于对照组(P<0.01),且随着患儿病情程度增加而增加(P<0.01)。各组HIE患儿斜视、眼球震颤、视神经萎缩发生率和眼部病变总发生率差异均有统计学意义(P<0.05~P<0.01)。 结论早期VEP检测可用于评估HIE患儿早期视觉发育障碍情况,对新生儿HIE的早期诊断、病情评估及指导治疗具有重要意义。 Abstract:ObjectiveTo explore the clinical value of early visual evoked potential(VEP) detection in children with hypoxic ischemic encephalopathy(HIE). MethodsOne hundred children with HIE were divided into the mild group(37 cases), moderate group(38 cases) and severe group(25 cases) according to the clinical classification standard of HIE, and 30 healthy infants in the same period were set as the control group.The latency and amplitude of flash evoked potential(F-VEP) and pattern evoked potential(P-VEP) were compared among four groups.The incidence rates of strabismus, eye flutter and optic nerve atrophy of eye function abnormalities were compared among three groups of HIE patients. ResultsThe amplitude of F-VEP and P-VEP in three groups of HIE patients were significantly lower than those in control group(P<0.01), and which decreased with the increasing of HIE degree(P<0.01).The latency in three groups of HIE patients were higher than that in control group(P<0.01), and which increased with the increasing of HIE degree(P<0.01).The differences of the incidence rates of strabismus, nystagmus, optic nerve atrophy and total incidence rate of ocular lesions among three groups of HIE patients were statistically significant(P<0.05 to P<0.01). ConclusionsEarly VEP detection can accurately evaluate the degree of brain injury and visual impairment of HIE neonates, which is of great significance for early diagnosis, disease evaluation and treatment guidance of HIE neonates. -
Key words:
- hypoxic ischemic encephalopathy /
- neonate /
- visual dysplasia /
- visual evoked potential
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表 1 各组VEP参数比较(x±s)
分组 n F-VEP振幅/V F-VEP潜伏期/ms P-VEP振幅/V P-VEP潜伏期/ms 对照组 30 10.20±2.53 116.14±5.95 10.80±2.17 103.99±6.3 HIE轻度组 37 8.67±1.43** 132.98±9.73** 7.53±1.48** 122.40±8.75** HIE中度组 38 5.36±1.20**△△ 160.08±11.18**△△ 5.01±0.95**△△ 134.13±9.30**△△ HIE重度组 25 2.79±0.92**△△## 198.31±12.41**△△## 2.66±0.73**△△## 176.62±11.34**△△## F — 120.505 353.29 168.029 316.813 P — <0.01 <0.01 <0.01 <0.01 MS组内 — 2.642 101.237 2.076 80.902 q检验:与对照组比较**P<0.01;与HIE轻度组比较△△P<0.01;与HIE中度组比较##P<0.01 表 2 各组HIE患儿眼部病变情况比较[n;百分率(%)]
分组 n 斜视 眼球震颤 视神经萎缩 总发生率 HIE轻度组 37 2(5.41) 2(5.41) 4(10.81) 8(21.62) HIE中度组 38 5(13.16) 4(10.53) 8(21.53) 17(44.74) HIE重度组 25 7(28.00) 6(24.00) 9(36.00) 22(88.00) χ2 — 6.36 5.01 5.71 26.52 P — <0.05 <0.05 <0.05 <0.01 -
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