早产儿和低体重儿的颅内出血CT检查与预后分析

CT SCAN AND PROGNOSES ANALYSIS OF PREMATURE INFANTS AND LOW WEIGHT INFANTS WITH INTRACRANIAL HEMORRHAGE

目的了解早产儿和低体重儿颅内出血(ICH)的发病情况、CT表现及预后。方法对200例早产儿和低体重儿进行头颅CT检查筛选,随访ICH患儿,定期复查头颅CT及进行智力发育检查,分析随访结果。结果200例早产儿和低体重儿中发现ICH53例,ICH检出率为26%。ICH部位依次为蛛网膜下腔出血(SAH)37例(70·6%),脑室周围-脑室出血(SEH/IVH)11例(20·8%),其中8例为胎龄<32w者,脑实质出血(IPH)4例(7·5%),小脑出血(ICEH)1例(1·1%),53例中死亡11例(20·8%)。随访42例,其中SAH占26例,SEH/IVH占11例,IPH占4例;随访正常24例(57·1%),后遗症18例(42·1%),主要表现为智力低下、脑瘫、癫痫。SAH预后较好,后遗症发生率11·5%(3/26例),但SEH/IVH及IPH的预后均差,后遗症发生率分别为87·5%(7/8例)和100%(2/2例)。结论早产儿和低体重儿ICH易漏诊,头颅CT筛选是非常必要的,预后与ICH部位关系密切,后遗症发生率高,应以预防为主。

Objective To investigate the pathogenic situation, CT findings andprognosis of premature infants and low weight infants with intracranial hemorrhage （ICH）. Methods Cranium CT scan was performed in 200 premature infants and low weight infants （ 1 ～ 30 days after birth）. Regular follow-up of head CT and intelligence development tests were taken in 45cases with ICH and the results were analyzed. Results 53 cases of ICH were indicated in 200 premature infants and low weight infants （26%）. 42 cases of them had history of asphyxia in labor and clinical symptoms （79. 2% ）, while 11 cases had not clinical symptoms （20. 8% ）. The locations of ICH were subarachnoid hemorrhage in 37 cases（ SAH 70. 6% ） ; pefiventrecular hemorrhage and intraventficular hemorrhage in 11 cases （SEH/IVH, 20. 8% ）, 8 cases of them were fetus dates 〈32 w; intraperenchymal hemorrhage 4 cases （IPH,7. 5% ） and interior cerebellar hemorrhage in 1 cases（ICEH- , 1.1% ）. 11 cases died （21%）. 42 cases were followed-up. 32 cases of SAH and 8 cases of SEH/IVH, 2 cases of IPH; 31 cases（69% ）of those were normal and 15 cases （31% ）remained sequelae. Main eomphcations were mental retardation （31% ）, cerebral palsy （100%） and epilepsy（ 100% ）. SAH had better prognosis with the sequelae rate of （ 17.2% ）, but SEH/IVH and IPH had poor prognosis with the sequelae rate of 87.5% and 100% ,respectively. Conclusion In the diagnosis of premature infants and low weight infants ICH can be easily missed, it is necessary to do head CT csan regularly. The prognosis is closely related to the location of ICH. The incidence of sequelae is high; prevention should be put into first consideration.