新生儿缺氧缺血性脑病的CT诊断及随访观察

CT diagnosis and follow up Study of neonatal hypoxic ischemic encephalopathy

目的:探讨新生儿缺氧缺血性脑病(hypoxicischemicencephalopathy,以下简称HIE)的发生发展及CT分级对临床诊断和治疗的意义。方法:选择HIE的足月新生儿110例,根据临床分级标准将患儿分为轻度、中度及重度3组,其中轻度43例、中度45例、重度22例。采用螺旋CT进行头颅扫描。按影像学分级标准分为轻、中、重三度,并将临床分度与CT分度资料经统计学处理进行比较分析。结果:110例HIE患儿脑CT平扫为不同程度的脑水肿征象,CT值在8～18Hu之间。诊断为轻度HIE的58例(53%),诊断为中度HIE的为38例(34%),诊断为重度HIE的为14例(13%),经统计学处理r=0.775,(P<0.01),认为CT分级与临床分级之间有密切的相关性,随着CT分级的增加,患儿的HIE状况也随之严重,其中伴蛛网膜下腔出血46例;脑室出血7例;硬膜下出血9例;脑实质出血4例。结论:CT扫描是检查HIE的主要手段,同时能准确显示病变部位和范围。CT对HIE的分度诊断,对该病的治疗及病情的严重程度判断提供了有利客观依据,可以作为重要的评价指标。

Objective：To investigate the happening and development of neonatal hypoxic ischemic encephalopathy（HIE） and the value of HIE grading using CT to direct the clinical diagnosis treatment.Methods：110 cases of asphyxial perinatal term birth neonates with hypoxic ischemic encephalopathy（HIE） were selected, and HIE was graded in three groups by clinical graduation ,which include 43 cases of mild, 45 cases of moderate and 22 cases of severe. Head scans were performed by spinal CT. Graduation were compared between clinical diagnosis and CT scanning.Results： In the110 HIE cases, hydrocephalus were exist to a great extent by CT scanning and CT value was 8-18 Hu.The mild degree of HIE was 58 （53%）, moderate degree was 38 （34%） and severe degree was 14 cases （13%） by CT graduation. A good consistence obtained between CT and clinical graduation r=0.775, P〈0.01. The more severe degree by CT,the more clinical graded. There were 46 cases with SAH, 7 cases with IVA, 9 cases with SDH and 4 cases with ICH.Conclusion：CT scanning is an accurate and effective technique for HIE＇s graduation and provides important information for clinical diagnosis and treatment.