新生儿缺氧缺血性脑病54例临床分析

Evaluation of hypoxia-ischemia encephalopathy in term newborn infants

目的:通过临床分度,新生儿行为测定,脑部CT检查对新生儿缺氧缺血脑病(HIE)进行临床评估,判断预后,以便早期进行干预治疗。方法:按照1996年杭州会议修订的HIE临床分类标准,将54例HIE患儿分为轻度13例,中度27例,重度14例,并对其进行新生儿行为神经测定。头颅CT扫描检查,随访至6个月时进行发育商评估,以DQ≥90为达标水平。结果:临床分度为轻、中度HIE者在6个月时DQ达标率无显著性差异。轻、中、重度HIE患儿在不同日龄NBNA评分有显著性差异(P<0.01),临床分度越重,NBNA评分越低。14d时NBNA≥35分和<35分者在6个月时DQ达标率有显著性差异,对判断HIE预后有重要意义。临床分析与颅脑CT分度符合率为83%,CT分度轻、中度在6个月时DQ达标率无显著性差异,中与重度有显著性差异,与预后有关。结论:只有将临床分度、NBNA评分、头颅CT三者结合起来,综合分析才能早期准确的判断HIE的程度和预后。

Objective：To judge prognosis of newborns suffered from hypoxia ischemia encephalopathy（HIE）by clinical grading,NBNA and brain CT scanning. Methods ：54 infants were divided into 3 groups according to the standard of HIE clinical grading, there were 13 in mild degree, 27 in moderate degree, 14 in serious degree. Then they were evaluated by neonatal behavioral neurological assessment （NBNA）, examined by brain CT scanning, followed-up by developmental quotient（DQ） until six months. Results ：There was no significant difference in the rate of normal DQat six months between mild and moderate degree of HIE; new borns significant differences were noted at different .lay. There was signiffcant difference in the rate of DQ reaching standard by six month between the HIE newborn with NBNA more than 35 and those with NBNA less than 35. The coincident rate between clinical grading and brain CT scanning was 83%. There was significant difference in the rate of DQ reaching standard by six month between morderate and severe degree of HIE evaluated by brain CT scanning. Conclusion ：Only by combining the climcal grading, NBNA and brain CT scanning ,can the degree and prognosis of HIE be early and exactly judged .