新生儿缺氧缺血性脑病CT随访再认识

Further recognition of CT follow-up of neonatal hypoxic ischemic encephalopathy

目的 :进一步探讨新生儿缺氧缺血性脑病 (HIE)的发展转归、CT分度与预后的关系 ,并评价CT在HIE随访中的应用价值。方法 :选择有围产期窒息史 ,头颅CT诊断为不同程度的HIE新生儿 62例。根据脑水肿范围、程度 ,将HIE分为轻、中、重 3度 ,分别于 3个月、6个月、1岁、2岁和 4岁内进行头颅CT复查。结果 :HIE所致脑低密度灶在生后3个月内吸收消失 ;3～ 6个月时可引起外部性脑积水 (EH) ,1岁以后 ,EH的表现消失 ;3个月及以后可引起脑室周围白质软化症 (PVL) ,其中轻、中、重度HIE的PVL发生率为 11.6%、64 .3 %和 80 % ;重度PVL的发生率为 2 0 %、3 3 .3 %和75 % ;重度HIE在 2个月内可引起脑软化和脑萎缩 ( 80 % )。结论 :HIE的CT分度与预后密切相关 ;轻度者 ,预后良好 ;中 重度者 ,预后较差。PVL。

Objective:To study the course and sequelae of neonatal hypoxic ischemic encephalopathy (HIE),the relation between the CT grading and the prognosis,and to assess the value of CT in follow-up of HIE.Methods:Sixty-two cases of asphyxial perinatal neonates were selected,and CT gradiag was made.HIE was graded into mild,moderate and severe degrees according to the extent and degree of cerebral edema.Follow-up was carried out at the 3rd,6th month,one and two years of age and before four years old.Results:Cerebral low density lesion was absorbed in 3 months;HIE might cause external hydrocephalus (EH) at 3rd-6th month,and EH disappeared one year later;HIE might cause periventricular leukomalacia (PVL) after the 3rd month.The incidence of PVL was 11.6%, 64.3% and 80%,respectively with mild,moderate and severe degree HIE,and that of severe degree PVL was 20%,33.3% and 75%. Severe degree HIE might cause cerebral malacia and atrophy (80%) in 2 months.Conclusions:Prognosis of HIE was closely related to the degree of abnormal manifestations on CT:Mild degree HIE might have good prognosis,moderate to severe degree HIE might have bad porgnosis. PVL,cerebral malacia and atrophy became late serious complications of HIE.