连续腰穿治疗新生儿脑室内出血24例观察

Observation of 24 newborns with intraventricular hemorrhage treated with serial lumbar punctures

目的探讨连续腰椎穿刺治疗新生儿脑室内出血(IVH)的疗效及预后。方法选择2000年12月以来我院新生儿科CT确诊的IVHⅡ级以上患儿24例行连续腰穿治疗,并进行随访。结果24例患儿开始LP时间为生后5～10天,平均(6.28±0.66)天。LP次数为5～15次,平均(10.40±3.20)次。持续时间7～31天,平均(15.62±5.31)天。放液量5～15ml,平均(8.1±2.7)ml。治愈后6个月复查头颅CT,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20例正常;随访时间10个月～4年,LP24例仅1例Ⅲ级IVH显示双侧脑室中度扩大发生脑瘫,余23例生长发育正常,预后不良发生率4.2%(1/24)。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,并可改善IVH患儿的不良预后。

Objective To explore the effect and prognosis of serial lumbar punctures （LP） in treating newborns with intraventricular hemorrhage （IVH）. Methods 24 newborns with grade Ⅱ-Ⅳ IVH diagnosed by CT were treated in our department since Gecember 2000 LP treatment （24 cases）. They were followed up. Results 24 cases, aged 5 to 10 days （average 6.82 ± 0.66 day） were treated with serial LP 5 to 15 times （averagel0.40 ± 3.20 times） for 7to 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 round in 2 of 3 cases with grade Ⅳ IVH in LP groups, external hydrocephalus was found in 1 case. Ome case with grade m IVH was found bilateral ventricles moderate enlargement and the remain 20 cases were normal. These patients were follow-up 10 months to ,4 years. Only one patient with grade Ⅲ IVH whose bilateral ventricles was moderately enlarged in Lp group developed cerebral palsy, others grow well. The ratio of bad prognosis was 1/24 （4.2%）.Conclusion Newborns with grade Ⅱ-Ⅳ IVH, especially severe cases, could be treated with serial LP early and actively, It can effectively prevent hydrocephalus and improve prognesis.