连续腰穿治疗新生儿脑室内出血的疗效观察及随访

Observation and follow-up of newborns with intraventricular hemorrhage treated with serial lumbar punctures

目的 探讨连续腰椎穿刺 (LP)治疗新生儿脑室内出血 (IVH)的疗效及预后。方法 选择 1997年 7月以来我院新生儿科CT确诊的IVHII级以上患儿 5 8例 ,分为同意LP治疗的LP组 2 9例和拒绝治疗的对照组 2 9例 ,进行随访。结果 2 9例患儿开始LP时间为生后 5～ 10d ,平均 (6 82±0 6 6 )d。LP次数为 5～ 2 5次 ,平均 (12 38± 3 78)次。持续时间 7～ 31d ,平均 (15 6 2± 5 31)d。放液量5～ 15ml,平均 (8 1± 2 7)ml。治愈后 6个月复查头颅CT ,LP组 3例IV级IVH中 2例显示双侧脑室轻度稳定扩大 ,1例发现有外部性脑积水 ,1例III级IVH显示双侧脑室中度扩大 ,余 2 5例正常 ;对照组9例显示双侧脑室中度以上扩大并进行性加重形成脑积水 ,余 2 0例正常。随访时间 10个月～ 6年 ,LP组 2 9例仅 1例III级IVH双侧脑室中度扩大发生脑瘫 ,余 2 8例生长发育正常 ,预后不良发生率 1/ 2 9(3 4 % ) ;对照组发生脑积水的 9例均发展成脑瘫 ,其中 1例随访 2年后死亡 ,预后不良发生率 9/ 2 9(31 0 % )。两组预后比较存在非常显著性差异 (χ2 =7 33,P <0 0 1) ,对照组预后较差。结论 IVHII级以上 ,尤其是严重IVH ,可早期采用积极主动的连续LP治疗 ,对预防IVH导致的脑积水效果显著 。

Objective To explore the effect and prognosis of serial lumbar punctures (LP) in treating newborns with intraventricular hemorrhage (IVH).Methods 58 newborns with grade II-IV IVH diagnosed by CT were treated in our department since July 1997.They were devided into two groups: LP treatment group (29 cases) and control group (29 cases).Then follow-up was carried out.Results 29 cases aged 5 to 10 days (average 6.82±0.66 days) were treated with serial LP 5 to 25 times (average 12.38±3.78 times) for 7 to 31 days (average 15.62± 5.31 days)and bloodletting 5～15 ml (average 8.1±2.7 ml).Brain CT scan was performed 6 months later and bilateral ventricles slightly stable enlargement was found in 2 of 3 cases with grade IV IVH in LP groups,external hydrocephalus was found in 1 case.One case with grade III IVH was found bilateral ventricles moderate enlargement and the remain 25 cases were normal.In control group,9 cases were found moderate,even severe,bilateral ventricles enlargement and progessively exacerbated hydrocephalus,20 cases were normal.These patients were follow- up for 10 months to 6 years.Only one patient with grade III IVH whose bilateral ventricles was moderatly enlarged in LP group developed cerebral palsy,others grow well. The percent of bad prognosis was 1/29(3.4%).But 9 cases with hydrocephalas in control groups all developed cerebral palsy,one died after 2 years.The percent of bad prognosis in control groups was 9/29(31.0%).The prognosis was signficant difference between two groups (χ\+2=7. 33,P<0.01).The prognosis of the control group was worse.Conclusion Newborns with grade II-IV IVH especially severe one,can be treated with serial LP early and actively,It can effectively prevent hydrocephalus and improve prognosis.