宫内缺氧所致Apgar评分正常的新生儿缺氧缺血性脑病

Clinical analysis of neonatal hypoxic-ischemic encephalopathy after intrauterine asphyxia with normal Apgar scores at birth

目的 分析宫内缺氧所致Apgar评分正常的新生儿缺氧缺血性脑病 (HIE)的临床特点及随访结果。 方法 2 0 0 2年 1月～ 12月我院收治的足月新生儿HIE 88例中 ,选择诊断为宫内缺氧所致HIE 30例进行分析。其诊断符合以下条件 :(1)有宫内缺氧史 ,出生Apgar评分 8～ 10分 ;(2 )生后早期出现神经症状 ;(3)排除感染、遗传代谢及畸形等神经系统疾病 ;(4)头颅B超或CT有HIE特征性改变。 结果 本组病例生后第 1天起均表现有轻度抑制症状 ,其中 2 2例间歇出现兴奋症状。临床症状属轻度者 17例 (5 7% ) ,中度 13例 (43% ) ,无一例重度 ,与出生时有窒息的 5 8例HIE比较差异无显著性。本组有不足 4 0 %病例有血尿素氮 (BUN)增高 ,低钠、低钙、低糖血症 ,代谢性酸中毒等并发症 ,与出生有窒息的HIE比较也基本一致。分别分析了单纯急性及慢性缺氧病例的B超改变 ,发现两者有所不同。本组随访 2 8例 ,出院后平均 (11.7± 3.8)个月 ,除一例脑瘫外 ,余体格、智能发育正常。B超复查 2 0例 ,出生时侧脑室扩大 4例、第 3脑室扩大 1例均恢复正常 ;出生时脑室不大 ,随访中出现脑室扩大者 6例 ,其中 1例为脑瘫 ,余者均恢复正常。 结论 胎儿有宫内缺氧史 ,新生儿出生时虽无窒息 ,但仍可发生HIE ,头颅B超可见有胎儿期脑损害 。

Objective To analyse the associated clinical findings of newborn infants with HIE after intrauterine asphyxia with normal Apgar scores at birth and follow-up the neurologic sequelae. Methods 30 newborn infants admitted for HIE in Jan.to Dec. 2002 were analysed,they had :(1)intra-uterine asphyxia with Apgar scores of 8～10 at birth,(2)with neurological symptoms on the first day after birth,(3)diseases of infection,genetics and metabolism,and deformity were ruled out,(4)with characteristic findings of HIE on cranial ultrasound examinations and CT scans. Results All of 30 newborn infants had signs of depression from the first day after birth,22 infants of them sometimes were irritable.17 cases (56.7%) with mild encephalopathy and 13 cases (43.3%) with moderate encephalopathy,none of severe case,compared with the infants who had HIE with birth asphyxia,there were no statistical difference. Less than 40% cases had elevated BUN and CKMB,hyponatremia,hypocalcemia,hypoglycemia,acidosis,etc The incidence of them were the same as the infants who had HIE with birth asphyxia. The findings of cranial ultrasound examinations were different between the acute and chronic hypoxic injury of intrauterine asphyxia Follow-up 28 infants at the mean age of (11.7±3.8) months. Except 1 case of cerebral palsy,all of them are normal intelligent infants. There were 4 cases of dilated lateral ventricle and 1 case of dilated 3rd ventricle at birth; 6 cases of dilated ventricles found in follow-up and 1 of them had cerebral palsy,all of those infants recovered at 12～19 months of age. Conclusion Newborn infants who had intrauterine asphyxia without birth asphyxia might suffer from HIE and cerebral palsy later. Cranial ultrasound examinations showed some of them had fetal brain damages. Therefore,intensive care of such infants,preventing and treating intrauterine asphyxia could decrease the morbidity of HIE.