新生儿严重脑室内出血连续腰穿的疗效

Serial Lumbar Puncture in the Treatment of Severe Intraventricular Hemorrhage in Neonates

目的为了治疗和预防脑室内出血后脑积水的发生和发展，改善新生儿严重脑室内出血的不良预后。方法1989年以来，对19例在出生后早期经头颅B超诊断为严重脑室内出血（IVH）患儿进行了连续腰穿（LP）治疗。结果有效16例，自动出院1例，失败2例。有效率为84．2％。有效16例初次LP日龄为14．6±5．7d，疗程23．4±12d，平均LP次数9．3±4．7次，平均LP间隔期3．1±1．6d，平均每次放液量6．7±2ml，LP治疗后起效天数为10．1±7．8d。2例在连续LP的同时联用乙酰唑胺治疗亦取得显著疗效。16例平均随访月龄为3．2±1月，体格发育均正常，B超显示12例脑室形态正常，4例脑室呈稳定的轻度增大。失败的2例初次LP迟，初期LP间隔期延长为7－9d，放液量＜5ml。同期另有17例严重IVH患儿未予LP治疗。其中4例并发脑积水，5例自动出院，4例早期死亡，余4例其后脑室形态稳定。结论连续LP不失为治疗新生儿严重IVH实用安全有效的方法，LP疗效欠佳时可联用乙酰唑胺治疗。

Objective To treat severe neonatal intraventricular hemorrhage so as to prevent the occurrence and development of posthemorrhagic hydrocephalus. Methods Since 1989 19 neonates with grade 3 intraventricular hemorrhage (IVH) were treated by serial lumbar punctures (LP) and the efficacy of intermittent LPs in prevention of posthemorrhagic hydrocephalus was assessed. Results Hydrocephalus was successfully prevented in 16 of the 19 infants, for whom spinal taps were started at an average postnatal age of 14.6±5.7 days and continued for 23.4±12days. Removal of 6.7±2ml of cerebrospinal fluid was conducted each time. An average of 9.3±4.7 taps with interval of 3.1±1.6 days was carried out. Two of 16 infants were given serial LP together with diamox for two weeks. A steady state of cerebrospinal fluid production and absorption was regained in all 16 infants at 10.1±7.8 days after therapy. The ventricular size was normal in 12 infants and enlarged slightly and steadily in 4 when these 16 infants were followed up at 3.2±1 months of age.Serial LP was interrupted against advice in one of 19 infants. The therapy of serial LP failed to prevent posthemorrhagic hydrocephalus in two infants. Delayed start of the therapy,the early period might probably play important roles for the failure. 17 neonates of another series with grade 3 IVH had not received the treatment of serial LP for certain reasons in the corresponding period. Among them, four infants died, five were discharged from hospital against advice within three weeks of age, and four developed hydrocephalus requiring surgical management. Only four infants whose ventricle stopped dilatation and kept stable in size at an average of 2.6 months got a better prognosis. CoDclusio' The results suggest that serial LP is effective in arresting the development of posthemorrhagic hydrocephalus and should be routinely undertaken for the neonates with grade 3 IVH.