导言

小儿临床脑电图指南应与指南l(临床脑电图操作的最低技术要求)联合使用。尽管指南1中概括的临床脑电图基本原则也适用于小儿，但我们将在下面讨论一些有关小儿脑电图记录的原则。指南2中括号内的数字特指指南1中应修改的部分，而指南2中未涉及的部分，指南1仍然适用并可供参考。

由于大龄儿童、青少年的脑电图记录与成人差别不大，我们将在指南2中更加强调新生儿、婴儿和幼儿的脑电图。由于新生儿脑电图记录还有很多特殊的问题，故指南2把儿童与新生儿的脑电图分成两部分来讨论。

l 儿童

1.1 (MTR 2.1)由于儿童，特别是小龄儿童在记录中活动较多，需要更耐心地放置电极。根据不同实验室的偏好，电极可以用固定胶或火棉胶来固定，但在整个记录过程中应仔细观察其位置和阻抗。最好使用银一氯化银盘状电极(带有可注入电解液的小孔)，没有必要也不应该使用针电极。

1.2 (MTR 2.3)大多数情况下应该使用国际10-20系统(Jasper HH，1958)中的21个电极。适用于成人的标准导联组合也同样适用于儿童。

1.3 (MTR 3.2)住院的小儿脑电图记录前，特别是对一些处于危险状况以致必须行床边脑电图检查的小儿而言，技术员应向护士详细了解患儿的情况和记录过程中的任何限制。

1.4 (MTR 3.4)由于小儿的脑电活动波幅较大龄儿童和成人高，应适当降低灵敏度(至10μV／mm或15μV／mm)。然而，为了足够显示低波幅的快活动，至少记录的一部分要使用高灵敏度(如7μV／mm)。否则，对于除婴儿之外的患者来说，可以在同一实验室采用与成人一样的设置。

1.5 (MTR 3.9)对合适的患儿可以在清醒期使用频率范围为1～20 Hz的闪光刺激。

1.6 (MTR 3.10)记录时应尽可能包括睁眼和闭眼阶段。对于超过3个月的婴儿而言，被动闭眼(技术员将手遮盖住患儿眼睛)一般都能成功地产生后头部的优势节律，类似于大人用双手遮住自己的脸，把脸一隐一现和婴儿玩捉迷藏的游戏。

1.7 (MTR 3.12)应尽可能地记录睡眠脑电图，但并不排斥清醒脑电图。患儿思睡期、睡眠开始时和觉醒期脑电的记录都有重要意义。能自然入睡最好，但如果要使用药物催眠，有必要在记录结束时使用各种方法将患儿唤醒以便能记录到觉醒期的脑电。

1.8 (MTR 3.13)记录开始时就应该标明患儿的状态。对小龄的患儿来说，技术员对患儿的持续观察并将其活动标注在脑电图记录上显得尤为重要。

英文原文

Introduction

These guidelines for clinical pediatric EEG should be considered in conjunction with the more general Guideline 1: Minimum Technical Requirements for Performing ClinicalElectroencephalography (MTR).

The basic principles of clinical EEG outlined in the MTR also apply to the very young and are reaffirmed. However, special considerations are pertinent to pediatric recordings and are discussed below. The numbers in parentheses in this Guideline refer specifically to sections of the MTR that must be modified in these special situations. Where a subject is not covered here,the recommendations of Guideline 1 remain appropriate and should be consulted.

Emphasis here will be on EEG in neonates, infants, and young children, since recording the EEGs of older children and adolescents differs little from recording the EEGs of adults. Because EEG recording in the newborn presents a number of special problems, this Guideline is divided into two parts setting forth recommendations for children and for neonates separately.

1. Children

1.1 (MTR 2.1) Because children, especially young children, have a tendency to move a good deal during recording, electrode application should be performed with great care. Electrodes may be applied with paste or collodion, according to the preference of the laboratory, but their positions and impedances should be monitored carefully throughout the study. The inverted saucer-shaped silver-silver chloride electrode with a small hole for the injection of electrolyte solution is best. Needle electrodes are not needed and should not be used.

1.2 (MTR 2.3) All 21 electrodes of the International 10-20 System (Jasper HH, 1958) should be used for most purposes. The standard montages used for adults should be used for children.

1.3 (MTR 3.2) Before recording the EEGs of young inpatients, especially those in so precarious a condition that the recordings must be done at bedside, the technician should consult with the nursing staff concerning the patient’s condition and any limitations on recording

procedures.

1.4 (MTR 3.4) The voltage of EEG activity in many young children is higher than that of older children and adults, and appropriate reduction of sensitivity (to 10 μV/mm or even 15μV/mm) should be used. However, at least a portion of the record should be run at a sensitivity (such as 7 μV/mm) adequate to display low-voltage fast activity. Otherwise, for patients beyond infancy, the same instrument control settings can be used as for adults in the same laboratory.

1.5 (MTR 3.9) Photic stimulation over the frequency range of at least 1—20 flashes/s should be used during wakefulness in appropriate patients.

1.6 (MTR 3.10) Whenever possible, recordings should include periods when the eyes are open and when they are closed. In infants over 3 months of age, passive eye closure(by placing the technician’s hand over the patient’s eyes) is often successful in producing the dominant posterior rhythm, as is the playing of game such as peek-a-boo.

1.7 (MTR 3.12) Sleep recordings should be obtained whenever possible, but not to the exclusion of the awake record. The recording of the patient during drowsiness,initiation of sleep,and arousal is important. Natural sleep is preferred, but if the use of sedation is necessary, all efforts should still be made to record arousal at the end of the recording.

1.8 (MTR 3.13) The patient’s condition should be clearly indicated at the beginning of the recording from every montage. Continuous observation by the technician, with frequent notations on the recording, is particularly important when recording young patients.

翻译：秦兵

编辑：格格