新生儿脑水肿临床诊断标准探讨

The research on clinical diagnostic criteria of neonatal encephaledema

目的 探讨新生儿脑水肿的临床诊断标准。方法 以１００ 例经腰穿测压及１３２ 例经尸体解剖确诊的新生儿脑水肿的临床资料对照小儿急性脑水肿协作组的临床诊断标准（ 简称“标准”） 进行分析。结果 “标准”中适合新生儿的临床观察指标仅有呼吸不规律、前囟饱满、血压增高、瞳孔扩大、昏迷昏睡、抽搐和（ 或） 肌张力改变六项，１４３ 例（６１６ ％ ） 符合“标准”，７８ 例（３３６ ％ ） 达不到“标准”，猝死１１ 例（４７ ％ ） ， 临床漏诊６３ 例（ 占尸解的４７７ ％ ） ，后三者以早产儿为多。结论 在具有严重缺氧、感染等原发病的基础上，出现以上六项中的任何一项临床指标即应怀疑脑水肿，出现二项即可诊断脑水肿。

Objective To research for clinical diagnostic criteria of neonatal acute encephaledema.Methods The clinical data was analysed for 232 neonates with encephaledema definitely diagnosed by autopsy and ICP measurement by lumbar puncture,and contrasted the diagnostic criteria proposed by Child Acute Encephaledema National Cooperating Team(abbreviated “criteria').Results The clinical signs in “criteria' fitted to neonates were only (1)The major signs: irregular respiration,pupil change,anterior fontanelle bulging,hypertension. (2)The minor signs:lethargy or coma,convulsion and/or remarked increase of muscle tension of extremities.143 cases (61 6%) fitted “criteria',78 cases (33 6%) did not,sudden death 11 cases (4 7%),underdiagnosed 63 cases(47 7% for autopsy).Conclusion The clinical diagnostic criteria for neonatal encephaledema were as follows:on the bases of primary diseases such as severe asphyxia or infection ,the disease should be suspected if any one of the 6 signs appeared,diagnosed if two signs were found.