新生儿行为神经测定及头颅CT在缺氧缺血性脑病预后评估中的价值

Value of NBNA and cranial CT in diagnosis of HIE

目的：探讨新生儿行为神经测定（NBNA）及头颅CT与新生儿缺氧缺血性脑病（HIE）的关系,使HIE诊断及预后评估更具科学性。方法：选择经临床检查诊断为不同程度的足月HIE患儿72例,分别于入院4~10天、28天进行头颅CT检查,并于同期及入院14天进行NBNA评分,3月、6月进行DQ值测定。结果：①生后4~10天CT分度与临床分度的一致性比较差异有显著性（P〈0.05）;②轻、中、重度HIE患儿在不同日龄NBNA评分差异均有显著性（P〈0.05）;③中、重度HIE患儿NBNA测定14天≤35分患儿组的DQ值低于14天〉35分组,统计学分析差异有显著性（P〈0.005）;④生后28天脑CT改变与预后关系密切。结论：早期头颅CT分度与临床分度一致性差;应用NBNA评分可判断HIE的病情轻重;动态NBNA及生后28天左右脑CT检查可作为HIE预后的早期评估依据,而生后14天的NBNA评分判断预后意义最大。

Objective： To study the relationship between HIE and NBNA and brain CT, and make diagnosis and prognosis assessment of HIE more scientifically. Methods ： The study involved 72 term neonates with HIE in varying degrees, who were diagnosed by clinical examinations. Brain CT examinations were carried out at the age of 4 ~ 10 days and 4 weeks respectively; NBNA were performed at the age of 4 ~ 10 days, 2 and 4 weeks respectively. DQ tests were performed at the age of 3 and 6 months. Results： （1）There was significant differ- ence in consistency between early brain CT and clinical examination to assessment of HIE degree （P 〈 0. 05） ; （2）There were significant differences in NBNA scores of HIE neonates at different days after birth （P 〈 0. 05） ; （3）DQ of the group which NBNA scores at the age of 14 days were less than 35 was lower than that of the other group which NBNA scores were more than 35. There were significant differences in NBNA scores between the two groups; （4） There was strong correlation between brain CT at the age of 28 days and prognosis of HIE. Conclusion： Consistency between early brain CT and clinical examination to assessment of HIE degree is poor. NBNA score can be used to determine the degree of HIE. Continuous evaluation of NBNA and brain CT at the age of 28 days can be early indicators of HIE prog- nosis assessment and NBNA score at the age of 14 days is the most important in HIE prognosis assessment.