新生儿脑积水侧脑室外引流术中并发症的临床分析

Clinical analysis the complications in the lateral ventricle drainage of newborn with hydrocephalus

目的分析新生儿脑积水侧脑室外引流手术中出现呼吸暂停和循环衰竭并发症的原因及与预后的关系。方法回顾性分析2003—2009年本院儿科新生儿病房因脑积水行侧脑室外引流手术的新生儿资料,分析手术过程中出现呼吸暂停、循环衰竭的可能原因,比较有无并发症患儿预后的差异。结果共14例新生儿进行侧脑室外引流术,5例患儿在侧脑室引流过程中出现呼吸暂停和(或)不同程度循环障碍(并发症组),9例患儿侧脑室引流过程顺利,引流后脑积水减轻,脑实质受压缓解(无并发症组)。并发症组患儿胎龄小[(31.6±1.9)周比(35.4±2.4)周]、出生体重低[(1532±439)g比(2360±742)g]、引流时脑积水持续时间长[(18.0±5.0)天比(4.5±2.6)天],大脑前动脉及大脑中动脉的舒张期流速明显低于无并发症组[(6.4±1.9)cm/s比(15.8±8.9)cm/s,(11.2±2.9)cm/s比(19.9±5.5)cm/s],P均<0.05。结论新生儿脑积水最佳治疗时机为发生脑积水后1周内,一旦脑积水时间超过2周,侧脑室外引流过程中可能出现呼吸暂停、循环衰竭等并发症,胎龄越小、出生体重越低,发生并发症的可能性越大。

Objective To analyze the reasons of apnea and circulatory failure during the lateral ventricle drainage of hydrocephalus and the relationship between these reasons and the prognosis.Methods Retrospectively analyze the reasons of apnea and circulatory failure during lateral ventricle drainage of the 14 cases hydrocephalus admitted to Peking University First Hospital pediatric ward from 2003 to 2009,analyze the reasons of apnea and circulatory failure during the operation,and compare the prognosis in the neonates with or without these complications.Results A total of 9 cases of neonatal hydrocephalus had uneventful lateral ventricle drainage,after that,hydrocephalus was improved and the pressure to the brain parenchyma was eased.5 patients had apnea and varying degrees of circulatory disturbance during the operation of the lateral ventricle drainage.The average gestational age of the children with complications was （31.6±1.9） w,significantly less than those without complications of （35.4±2.4） w;the average birth weight of the children with complications was （1532±439） g,significantly smaller than those without complications of （2360±742） g.The average of treatment duration of the children with complications was （18.0±5.0） d,significantly longer than those without complications of （4.5±2.6） d.The diastolic velocity of cerebral artery and middle cerebral artery in the children with complications were （6.4±1.9） cm/ s and （11.2±2.9） cm/ s,significantly lower than those without complications of （15.8±8.9） cm/ s and （19.9±5.5） cm/ s.Conclusions The best treatment time of the neonatal hydrocephalus is 1 week after the occurrence;and after 2 weeks,the possibility of occurrence complications of apnea and circulatory failure may be elevated during the operation of ventricle drainage;besides,the more possibility of complications will happen in the neonates with the lower gestational age and lower birth weight.