脑氧饱和度在早产儿脑损伤中的动态变化及与振幅整合脑电图参数、神经发育的关联

doi:10.3969/j.issn.1006-5725.2025.16.004

Abstract

Abstract:

Objective To investigate the expression of regional cerebral oxygen saturation （rSO₂） in preterm infants with brain injury （BIPI） and its relationship with amplitude-integrated electroencephalogram （aEEG） parameters and neurodevelopment. Methods Retrospectively， 116 cases of BIPI （Bilateral Intra-ventricular Perforation） born in the hospital between February 2022 and February 2023 were selected as the study subjects. According to the Expert Consensus on the Diagnosis and Prevention of Premature Infant Brain Injury， these cases were categorized into mild， moderate， and severe groups， with 59，35， and 22 cases， respectively. The study compared the general characteristics of premature infants with different brain injury levels. Regression analysis was conducted to identify the factors affecting brain injury in premature infants， and correlation analyses were performed on aEEG scores， rSO₂， and GMS scores. ROC curve analysis was used to evaluate the value of combining brain oxygen saturation monitoring with aEEG in predicting abnormal whole-body motor quality assessment. Results On the 3rd and 7th days after birth， severe brain-injured premature infants had significantly lower rSO₂ and aEEG scores compared to those with mild and moderate brain injuries （P < 0.05）. At 7 days， these infants also had lower scores for graph continuity， sleep-wake cycles， lower boundary amplitude， bandwidth， total score， rSO₂， gestational age， and birth weight， and a higher proportion of abnormal developmental outcomes （PR+CS）（P < 0.05）. Multivariate logistic regression analysis revealed that the 3-day aEEG total score （OR = 0.448，95%CI：0.094~0.890），7-day aEEG total score （OR = 0.384，95%CI：0.058~0.726），3-day rSO₂（OR = 0.574，95%CI：0.398~0.750）， and 7-day rSO₂ （OR = 0.431，95%CI：0.115~0.777） were all protective factors for brain injury in premature infants， P < 0.05. Correlation analysis showed that brain oxygen saturation was negatively correlated with aEEG scores and overall motor quality. The prediction value for abnormal overall motor quality using 7-day rSO₂， aEEG， and the combination of 7-day rSO₂ and 7-day aEEG scores was as follows： the positive predictive value for rSO₂ was 86.46%， the negative predictive value was 96.85%， the sensitivity was 92.31%， the specificity was 92.21%， and the cut-off value was 0.845； The positive predictive value （PPV） of aEEG was 78.26%， the negative predictive value （NPV） was 96.86%， the sensitivity was 89.74%， and the specificity was 92.21%， with a cut-off value of 0.820. The positive predictive value （PPV） of 7-day rSO2 combined with 7-day aEEG score was 89.04%， the NPV was 96.88%， the sensitivity was 94.90%， and the specificity was 93.51%， with a cut-off value of 0.884， P < 0.05. ROC curve analysis showed that the AUC of 7-day rSO₂ + 7-day aEEG score was 0.895， De-long test P < 0.005， indicating high predictive value for overall exercise quality. Conclusion Combined with rSO₂ and EEG， the prediction of overall motor quality is better， which may have clinical value for excluding high-risk children.

Key words: brain oxygen saturation, preterm infants, brain injury, amplitude-integrated EEG parameters, neurodevelopment

CLC Number:

R722.1

Huanhuan MA,Xiaojing LIU,Zhimei SI,Jingjing XU,Xuemin QIE. Study on the dynamic changes of brain oxygen saturation in premature infant brain injury and its correlation with amplitude integrated EEG parameters and neurodevelopment[J]. The Journal of Practical Medicine, 2025, 41(16): 2461-2469.

Figures/Tables 9

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References 26

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评估维度	评分	具体标准
睡眠-觉醒周期	0	完全缺失，无周期性电压变化
	1	不成熟周期（周期< 30 min或振幅变化不明显）
	2	成熟周期（周期≥ 30 min，振幅变化明显）
信号连续性	0	极度不连续（基线振幅< 5 μV，爆发间隔>30 s）
	1	中度不连续（基线振幅5 ~ 10 μV，爆发间隔10~30 s）
	2	连续（基线振幅> 10 μV，无显著中断）
最低振幅值	0	< 5 μV
	1	5 ~ 10 μV
	2	> 10 μV
带宽和最小值（振幅范围）	0	带宽极小（< 5 μV）
	1	5 ~ 15 μV
	2	15 ~ 30 μV
	3	30 ~ 45 μV
	4	> 45 μV

指标	第3天			t/χ²值	P值
指标	轻度（n = 59）	中度（n = 35）	重度（n = 22）	t/χ²值	P值
aEEG/分
连续性	1.42 ± 0.24	1.37 ± 0.21	1.30 ± 0.18	2.437	0.092
睡眠?觉醒周期	1.42 ± 0.38	1.36 ± 0.31	1.29 ± 0.28	1.215	0.301
下边界振幅	1.46 ± 0.32	1.39 ± 0.26	1.29 ± 0.28	2.727	0.070
带宽和最小值	3.10 ± 0.88	2.97 ± 0.69	2.85 ± 0.57	0.912	0.405
总分	7.91 ± 1.05	7.01 ± 2.28	6.53 ± 2.11	6.299	0.003
rSO₂/%	67.85 ± 6.42	63.39 ± 6.61	57.49 ± 6.58	21.089	0.000

指标	例数（n = 116）	第7天			t/χ2值	P值
指标	例数（n = 116）	轻度（n = 59）	中度（n = 35）	重度（n = 22）	t/χ2值	P值
图形连续性/分	1.51 ± 0.41	1.50 ± 0.39	1.45 ± 0.41	1.39 ± 0.42	0.631	0.534
睡眠-觉醒周期/分	1.44 ± 0.53	1.42 ± 0.39	1.38 ± 0.37	1.32 ± 0.29	0.609	0.546
下边界振幅/分	1.34 ± 0.39	1.33 ± 0.34	1.29 ± 0.36	1.26 ± 0.38	0.357	0.701
宽带和最小值/分	3.19 ± 0.78	3.15 ± 0.71	3.05 ± 0.69	2.99 ± 0.63	0.513	0.600
总分/分	7.73 ± 2.41	7.72 ± 1.03	7.15 ± 2.33	6.61 ± 2.11	3.578	0.031
rSO_2/%	63.46 ± 15.48	61.79 ± 8.21	57.83 ± 7.18	55.76 ± 7.35	5.939	0.004
男性/［例（%）］	66（56.90）	33（55.93）	20（57.14）	13（59.09）	0.066	0.967
孕周/周	30.53 ± 3.21	31.67 ± 2.07	30.59 ± 1.86	29.11 ± 1.79	14.161	< 0.001
孕周/［例（%）］					0.6321	0.748
< 32周	55（47.41）	27（45.76）	18（51.43）	10（45.45）
≥ 32周	61（52.59）	31（52.54）	21（60.00）	9（40.91）
出生体质量/g	1 304.90 ± 439.87	1 576.25 ± 168.51	1 357.35 ± 203.36	1 124.75 ± 259.72	44.157	< 0.001
1 min阿普加评分/分	5.12 ± 1.38	5.28 ± 1.22	5.06 ± 1.23	4.95 ± 1.21	0.724	0.487
5 min阿普加评分 /分	6.16 ± 1.49	6.35 ± 1.29	6.29 ± 1.42	6.24 ± 1.57	0.056	0.945
剖宫产/［例（%）］	95（81.90）	47（79.66）	29（82.86）	19（86.36）	0.517	0.772
妊娠并发症/［例（%）］	96（82.76）	48（81.36）	29（82.86）	19（86.36）	0.282	0.869
全身运动质量/［例（%）］					7.532	0.023
NF	77（66.38）	46（77.97）	20（57.14）	11（50.00）
异常（PR+CS）	39（33.62）	13（22.03）	15（42.86）	11（50.00）
合计	116（100.00）	59（100.00）	35（100.00）	22（100.00）
产妇年龄/岁	28.09 ± 6.26	27.41 ± 4.83	27.17 ± 4.16	26.45 ± 3.87	0.555	0.576

指标	3 d rSO?	7 d rSO?	3 d aEEG评分	7 d aEEG评分	全身运动质量
3 d rSO?	1.000	-	-	-	-
7 d rSO?	0.035^*	1.000	-	-	-
3 d aEEG评分	0.047	0.267^*	1.000	-	-
7 d aEEG评分	0.107^*	0.032^*	0.049	1.000	-
全身运动质量	-0.256	-0.096^*	-0.024	-0.027^*	1.000

全身运动质量诊断结果	例数	7 d rSO₂		7 d aEEG评分		7 d rSO₂+7 d aEEG评分
全身运动质量诊断结果	例数	阳性	阴性	阳性	阴性	阳性	阴性
合计	116	107	9	106	10	109	7
异常	39	36	3	35	4	37	2
正常	77	71	6	71	6	72	5

Study on the dynamic changes of brain oxygen saturation in premature infant brain injury and its correlation with amplitude integrated EEG parameters and neurodevelopment

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检测方法	真阳性	假阳性	真阴性	假阴性	灵敏度/%	特异度/%
7 d rSO₂	36	3	71	6	92.31	92.21
7 d aEEG评分	35	4	71	6	89.74	92.21
7 d rSO₂+7 d aEEG评分	37	2	72	5	94.90	93.51

检测方法	AUC	De-long test P值	阳性预测值/%	阴性预测值/%	灵敏度（95%CI）/%	特异度（95%CI）/%	截断值
7 d rSO₂+7 d aEEG评分	0.895	0.004	89.04	96.88	94.90（87.38 ~ 98.62）	93.51（86.24 ~ 97.93）	0.884
7 d aEEG评分	0.889	0.011	78.26	96.86	89.74（80.70 ~ 95.89）	92.21（84.14 ~ 97.55）	0.820
7 d rSO₂	0.795	0.009	86.46	96.85	92.31（84.03 ~ 97.56）	92.21（84.14 ~ 97.55）	0.845

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