新生儿缺氧缺血性脑病CT诊断及预后探究

Diagnostic and prognostic values of CT in neonate hypoxic and ischemic encephalopathy

目的研究新生儿缺氧缺血性脑病（HIE）的CT诊断及预后，探讨临床分度、窒息程度与CT分度的关系，以及CT分度与预后的关系，提高对该病的CT影像学认识。方法对83例有明确窒息史．且临床确诊为HIE的患儿进行临床资料和CT资料的整理分析。结果79例HIE患儿CT显示不同程度异常，主要表现为脑水肿、脑梗死。同时有合并颅内出血（42例），其中单纯蛛网膜下腔出血（SAH）最为多见（28／42），混合出血次之（14／421。HIE临床分度与CT分度基本一致（r=0．7989，tr=11．95，P〈0．01）；窒息程度与CT分度呈正相关（r=0．692，tr=8．63，P〈0．011，程度越深，CT分度越重，脑损害也越严重；复诊CT资料显示CT轻、中度异常病例脑实质低密度范匍逐渐缩小或消失．SAH完全吸收。重度混合型颅内出血及脑梗死演变成局部软化灶、脑萎缩、脑积水、脑组织钙化、脑穿通畸形，随访死亡3例。HIE的预后与CT分度有密切关系（χ^2=30．95，P〈0．01），分度越重预后越差。结论HIE的CT表现主要为脑水肿、脑梗死和并发颅内出血，是CT诊断HIE的主要影像学依据。SAH是HIE的最常见并发症，CT检查能为临床HIE的诊断、治疗和评价预后提供客观科学依据。

Objective To explore the relationship between the clinical grades, severity of asphyxia and CT grades, and to investigate the CT value in predicting the outcomes in neonates with hypoxia and ischemia encephalopathy （HIE）. Methods A total of 83 neonates that had obvious history of asphyxia and were diagnosed as HIE were studied. Their clinic and CT data were carefully analyzed. Results Seventy-nine of 83 HIE neonates CT showed significant abnormalities in various extents. Main manifestations included cerebral edema, infarction, and intracranial hemorrhage. Pure subarachnoid hemorrhage （SAH） was detected most often （28 out of 42） among the intracranial hemorrhage, and followed by complex hemorrhage （14 out of 42）. HIE clinic grades were consistent with CT grades （r=0.798 9, tr= 11.95, P〈0.01） ; while severity of asphyxia and CT grades were significantly correlated （r=0.692, tr=8.63, P〈0.01）,i.e. more serious asphyxia resulted in higher CT grade indicating more severe brain damage. Follow-up CT showed that the brain parenehyma with mild or mediate abnormalities on initial CT, the hypodense lesions shrank or even disappeared, and SAH was absorbed completely. However, the severe complex intraeranial hemorrhage and cerebral infarction resulted in local encephalomalaeia, atrophy, hydrocephalus, parenchymal calcification, and porencephalia. Three patients died during the follow-up period （χ2=30.95, P〈 0.01）. Conclusion Cerebral edema, infarction, and intracranial hemorrhage are key CT signs in diagnosis of HIE. SAH is the most frequent complication of HIE. CT can provide objective evidences in the diagnosis and prognosis assessment of HIE.