接上篇：小儿脑电图最低技术标准（一）

2 新生儿与小婴儿脑电图（足月产后4 ~ 8周）

2.1 (MTR 1.1)必须使用至少有16个信号通道的仪器。通常要使用2个或更多的信道记录非脑电的“多形性”变异波，如心电和呼吸。16个或更多的通道可灵活变通。

由于新生儿清醒一睡眠周期的脑电图模式不如成人和年长儿童那么确切，为了准确评价患儿在记录时的状态，通常我们也同步记录(非脑电)的多形联组合，为了给脑电图工作室之间提供标准化的参考性变异波，它们有助于鉴别生理伪差；例如显著的单形性δ活动常常可能是呼吸伪差，因为婴儿的呼吸频率可达100次/min以上。此外一些“非脑电”的变异也可能直接与患儿的临床问题相关。例如在发作性窒息患儿中，记录呼吸和心率的改变对诊断更有意义。

在婴儿，最常与脑电一起要监测的参数通常包括：呼吸、眼动、心跳。通过颏下肌电图(EMG)或运动传感器记录肌肉的电活动常也很有意义。

呼吸电图可由以下方法来记录：（1）腹部和(或)胸腔应变仪；（2）胸廓电极间的阻抗变化(呼吸阻抗图)；（3）气道热敏电阻或热电偶。如果婴儿有呼吸问题，最好能再用3或4个信道以便同时监测腹部和胸部运动及上呼吸道气流。对于没有呼吸问题的婴儿来说，一个用于记录腹部或胸部呼吸电图的信道就足够了。

为了记录眼动，可以将一个电极放置在一只眼睛上方0.5 cm、稍微靠近一侧外眦处，另一个电极放置在另一只眼睛下方0.5 cm、稍微靠近该侧外眦处。分别命名为E1和E2。可以通过连接眼至耳极的电极监测到水平和垂直性眼动。E1与A1相连，E2与A1相连(或E1—A2，E2一A2)。

尤其发现患儿有心脏、呼吸问题或发现节律性的伪差时，应常规记录心电图。

2.2 (MTR 2.1)电极可用火棉胶或固定胶来固定。最好使用银一氯化银盘状电极(带有可注入电解液的小孔)。对新生儿来说，丙酮和乙醚都不能使用，附有电解液的盘状电极最好。不要使用针型电极。

2.3 (MTR 2.3)是否减少电极阵列通常对新生儿来说是个体化的选择。一些脑电图医生偏好使用10～20系统，而另一些则偏好使用减少了的电极阵列。一般认为对于头部较小的早产几或在新生儿重症监护室内，由于时间或其他环境不允许使用全部电极阵列的时候，可以接受减少的电极阵列。然而如果能有20个信道的话，使用16信道的成人标准导联组合再加上其他记录非脑电的信道还是可行的。

以下是最少的电极阵列建议：Fp1、Fp2、C3、Cz、C4、T7(T3)、T8(T4)、O1、O2、A1和A2。如果患儿的耳垂太小，可以用乳突电极代替，并命名为M1和M2。前额电极(Fp1和Fp2)也可以用Fp3和Fp4替代。Fp3位于Fp1和F3之间的中点，Fp4位于Fp2和F4之间的中点（注意：由于Fp3和Fp4电极的使用会导致头皮电极间的间隔不完全相等）。

对于婴儿和儿童来说，通过测量来确定电极放置的位置与成人一样重要。只有在不可能或临床上不允许对患儿的头部进行测量的情况下才能违反这一原则。如果由于静脉通道、测压螺栓、头皮血肿或其他类似的原因而必须调整电极位置的话，对侧相应位置的电极也必须做同样的调整。如果没有进行测量的话，技术员必须在记录中予以说明。

2.4 (MTR 2.4)电极阻抗常规要小于5 kΩ，但为了避免过分操作或过度磨损娇嫩的皮肤，也允许使用更高的阻抗。最重要的是要避免电极间阻抗有明显的不同。

英文原文

2. Neonates and Young Infants (Up to 4-8 Weeks Post-Term)

2.1 (MTR 1.1) Instruments with at least 16 channels should be used. Two, and often more,channels must be devoted to recording non-EEG “polygraphic” variables, such as EKG and respiration. Sixteen or more channels allow the necessary flexibility.

Because EEG patterns seen in the neonate are not as clearly related to stages of the wake-sleep cycle as are those of adults and older children, it is usually necessary to record polygraphic (non-EEG) variables along with the EEG in order to assess accurately the baby’s state during the recording. Polygraphic recording is also helpful in identifying physiologic artifacts; for example,apparent monomorphic delta activity often turns out to be respiration artifact, since babies may have respiratory rates of up to 100/min. Moreover, variables other than the EEG may be directly pertinent to the patient’s problems. For example, in those experiencing apneic episodes,breathing and heart rate changes are most relevant.

The parameters most frequently monitored along with EEG in infants are respirations, eye movements, and heartbeats. A recording of muscle movements, by submental electromyography (EMG) or movement transducer, also can be quite helpful.

Respirogram can be recorded by any of the following means: (1) abdominal and/or thoracic strain gauges,(2) changes in impedance between thoracic electrodes (impedance pneumogram), or (3) airway thermistors/thermocouples. In infants with respiratory problems, it is necessary to devote three or four channels to respiration in order to monitor both abdominal and thoracic movements, plus airflow in the upper airway. In infants without respiratory problems, one channel of abdominal or thoracic respirogram may be sufficient.

For recording eye movements, one electrode should be placed 0.5 cm above and slightly lateral to the outer canthus of one eye and another 0.5 cm below and slightly lateral to the outer canthus of the other eye. These can be designated E1 and E2. Both lateral and vertical eye movements can be detected by linking (referring) eye movement to auricular electrodes: E1 to A1 and E2 to A1 (or E1-A2, E2-A2).

EKG should be recorded routinely, and is particularly needed when there are cardiac or respiratory problems or when rhythmic artifacts occur.

2.2 (MTR 2.1) Electrodes may be applied with either collodion or paste. The inverted saucershaped silver-silver chloride electrode with a small hole for the injection of electrolyte solution is best. For neonates, the fumes of acetone and ether may not be acceptable, and disk electrodes with electrolyte paste are preferable. Needle electrodes should never be used.

2.3 (MTR 2.3) It is a matter of individual preference whether or not a reduced array is routinely acceptable for neonates. Some electroencephalographers prefer the full 10—20 array; others prefer a reduced array. It is generally agreed that a reduced array is acceptable in cipremature infants with small heads or where, as in neonatal intensive care units, time or otherrcumstances may not allow application of the full array. However, if 20 channels are available,it is possible to use standard adult 16-channel montages plus polygraphic variables.

The following electrodes are suggested as a minimum reduced array: Fp1, Fp2, C3, Cz, C4, T7(T3), T8 (T4), O1, O2, Al, and A2. If a baby’s earlobes are too small, mastoid leads may be substituted and can be designated Ml and M2. Acceptable alternative frontal placements in the reduced array are Fp3 and Fp4 instead of Fp1 and Fp2. Fp3 and Fp4 are halfway between the Fp1 and F3, and the Fp2 and F4 positions, respectively. (Note that the use of Fp3 and Fp4 makes for unequal interelectrode distances in scalp-scalp montages.)

Determining electrode sites by measurement is just as important in infants and children as in adults. Deviation from this principle is permissible only in circumstances in which it is impossible or clinically undesirable to manipulate the child’s head to make the measurements. If an electrode placement must be modified due to intravenous lines, pressure bolts, scalp hematomas, and the like, the homologous contralateral electrode placement should be similarly modified. If no measurements are made, the technologist should note this on the recording.

2.4 (MTR 2.4) Electrode impedances of less than 5 KOhms can be obtained regularly,although higher impedances may be allowed in order to avoid excessive manipulation or excessive abrasion of tender skin. It is most important that marked differences in impedances among electrodes be avoided.

翻译：秦兵

编辑：格格