彩色多普勒超声参数联合振幅整合脑电图对新生儿脑损伤预后的预测效能分析

Analysis of the predictive efficiency of combined color doppler ultrasound parameters and amplitude-integrated electroencephalography in neonatal brain injury

摘要:

目的 探讨彩色多普勒超声参数与振幅整合脑电图（aEEG）联合应用对新生儿脑损伤预后的预测效能。方法 选取2021年1月—2024年1月亳州市人民医院收治的92例脑损伤新生儿作为研究对象，根据新生儿行为神经测定量表（NBNA）评分分为预后不良组21例和预后良好组71例。同时选取50例非脑损伤新生儿作为对照组。采用彩色多普勒超声检测脑血流动力学参数，使用aEEG记录脑电活动；采用多因素一般Logistic回归分析影响新生儿脑损伤预后的危险因素；绘制受试者工作特征（ROC）曲线评估彩色多普勒超声参数联合aEEG的预测效能。结果 观察组患儿收缩期峰值血流速度（Vs）、舒张末期血流速度（Vd）均低于对照组（P <0.05），阻力指数（RI）高于对照组（P <0.05）。观察组患儿上边界电压、窄带宽度均高于对照组（P <0.05），下边界电压低于对照组（P <0.05）。预后不良组患儿体重、Vs、Vd和下边界电压均低于预后良好组（P <0.05），预后不良组患儿RI、上边界电压和窄带宽度均高于预后良好组（P <0.05）。多因素一般Logistic回归分析结果显示：Vs降低［O^R =0.165（95% CI：0.043，0.629）］、Vd 降低［O^R =0.158（95% CI：0.066，0.377）］、RI升高［O^R =2.968（95% CI：1.199，7.346）］、上边界电压升高［O^R =2.633（95% CI：1.161，5.972）］及下边界电压降低［O^R =0.295（95% CI：0.115，0.759）］均为脑损伤新生儿预后不良的危险因素（P <0.05）。ROC曲线结果显示，Vs、Vd、RI、上边界电压、下边界电压联合预测的曲线下面积为0.979（95% CI：0.952，1.000），敏感性为95.2%（95% CI：0.762，0.999），特异性为97.2%（95% CI：0.902，0.997）。结论 彩色多普勒超声参数联合aEEG能有效预测新生儿脑损伤患儿预后，为临床提供关键的评估信息。

Abstract:

Objective To investigate the predictive efficiency of combined application of color Doppler ultrasound parameters and amplitude-integrated electroencephalography (aEEG) in neonatal brain injury.Methods A total of 92 neonates with brain injury treated at Bozhou People's Hospital from January 2021 to January 2024 were selected for the study. Based on the Neonatal Behavioral Neurological Assessment (NBNA) scores, the patients were divided into a poor prognosis group (n = 21) and a good prognosis group (n = 71). Additionally, 50 neonates without brain injury were enrolled as the control group. Cerebral hemodynamic parameters were detected using color Doppler ultrasound, and brain electrical activity was recorded with aEEG. Multivariate regression analysis was applied to determine the influencing factors of poor prognosis in neonatal brain injury, and the diagnostic efficacy of the combined use of color Doppler ultrasound parameters and aEEG was evaluated using ROC curves.Results In the study group, systolic peak blood flow velocity (Vs) and end-diastolic blood flow velocity (Vd) were significantly lower than those in the control group (P <0.05), while the resistance index (RI) was significantly higher (P <0.05). Upper boundary voltage and narrow bandwidth were significantly higher in the study group, and lower boundary voltage was significantly lower (P <0.05). In the poor prognosis group, birth weight, Vs, Vd, and lower boundary voltage were significantly lower than those in the good prognosis group (P <0.05), while RI, upper boundary voltage, and narrow bandwidth were significantly higher (P <0.05). Multivariate logistic regression analysis revealed that decreased Vs [O^R = 0.165 (95% CI: 0.043, 0.629) ], decreased Vd [O^R = 0.158 (95% CI: 0.066, 0.377) ], increased RI [O^R = 2.968 (95% CI: 1.199, 7.346) ], increased upper boundary voltage [O^R = 2.633 (95% CI: 1.161, 5.972) ], and decreased lower boundary voltage [O^R = 0.295 (95% CI: 0.115, 0.759) ] were independent risk factors for poor prognosis in neonates with brain injury (P <0.05). The ROC curve analysis showed that the combination of Vs, Vd, RI, upper boundary voltage, and lower boundary voltage had the highest area under the curve (AUC) at 0.979 (95% CI: 0.952, 1.000), with a sensitivity of 95.2% (95% CI: 0.762, 0.999) and specificity of 97.2% (95% CI: 0.902, 0.997).Conclusion The combination of color Doppler ultrasound parameters and aEEG effectively predicts the prognosis of neonatal brain injury, providing critical information for clinical assessment.