新生儿缺氧缺血性脑病的CT随访观察

CT follow up survey of neonatal hypoxic ischemic encephalopathy

目的：研究新生儿缺氧缺血性脑病（ｈｙｐｏｘｉｃｉｓｃｈｅｍｉｃｅｎｃｅｐｈａｌｏｐａｔｈｙ，以下简称ＨＩＥ）的发展规律及其预后情况。材料与方法：选择有围产期窒息史、头颅ＣＴ诊断为不同程度ＨＩＥ的新生儿８３例，分别于３个月、６个月、１岁、２岁和４岁以前进行头颅ＣＴ和临床复查。结果：３个月时５６％病例有头颅ＣＴ异常，大部分表现为外部性脑积水，２８％病例有神经系统的症状和体征。６个月时３３％病例有ＣＴ异常，３３％病例有临床表现。１岁以后约２０％病例有ＣＴ异常，表现为局限性脑软化灶和脑萎缩，并有相应的临床表现。结论：（１）ＨＩＥ所致脑质低密度灶在生后２～３个月内吸收消散。（２）ＨＩＥ在３个月时有半数病例头颅ＣＴ表现异常，大部分表现为外部性脑积水，１岁以后，外部性脑积水愈合，约２０％病例留有局限性脑软化和脑萎缩等严重后遗症。（３）ＨＩＥ的预后与ＣＴ分度密切相关，轻度者预后良好，中、重度者预后差。

Purpose: To study the evolution of neonatal hypoxic ischemic encephalopathy (HIE). Materials and methods: Eighty three cases of asphyxial perinatal neonates were selected, and HIE was diagnosed on CT. Follow up study was carried out at the 3rd, 6th month, one and two years of age, and before four years old. Results: At 3rd month, 56% cases were abnormal on CT, mostly showing external hydrocephalus (HE). 28% cases had clinical manifestations of nervous system. At 6th month, 33% cases were abnormal on CT. 33% cases had clinical manifestations. After one year, about 20% cases had abnormal CT with localized cerebral softening and atrophy, and corresponding clinical manifestations. Conclusion: (1) Cerebral low density lesion was absorbed in 2 3 months; (2) At 3rd month, about half of the cases had abnormal CT, mainly HE. After one year, HE was recovered, and 20% cases had serious complications such as localized cerebral softening and atrophy. (3) Prognosis of HIE was closely related to the degree of abnormal manifestations on CT.