新生儿脑室内出血CT诊断及随访研究

CT diagnosis and follow-up study of intraventricular hemorrhage in neonates

目的：探讨新生儿脑室内出血（ＩＶＨ）的发病机理、预后与ＣＴ分级的关系，评价其ＣＴ诊断及随访价值。方法： ６０例经ＣＴ诊断为ＩＶＨ患儿，早产儿１９例，足月儿４１例，生后１周内作首次头颅ＣＴ扫描，１个月后进行ＣＴ随访观察。结 果：ＣＴ表现为不同程度的ＩＶＨ，侧脑室内出血５９例，侧脑室及第三脑室内出血１例；室管膜下出血（ＳＥＨ）１８例，早产儿１２ 例；脉络丛出血２４例，足月儿１９例；侧脑室轻度扩大１１例，急性梗阻性脑积水４例；脑实质内出血（ＩＣＨ）１１ 例，硬膜下血肿 （ＳＤＨ）３例，蛛网膜下腔出血（ＳＡＨ）４９例，缺氧缺血性脑病（ＨＩＥ）４６例。根据有无侧脑室扩大及ＩＣＨ，将本组新生儿ＩＶＨ分 为３级：Ⅰ级单纯ＩＶＨ４５例；Ⅱ级ＩＶＨ伴侧脑室扩大１０例；Ⅲ级ＩＶＨ伴侧脑室扩大、ＩＣＨ５例。随访中，１９例出现后遗ＣＴ改 变：Ⅰ级５例，均为侧脑室轻度扩大；Ⅱ级９例，侧脑室轻度扩大５例，梗阻性脑积水４例；Ⅲ级５例，侧脑室轻度扩大１例， 梗阻性脑积水３例，脑萎缩３例，脑软化灶４例。结论：Ⅰ级ＩＶＨ预后良好；Ⅱ、Ⅲ级ＩＶＨ预后较差。因此头颅ＣＴ扫描在新 生儿ＩＶＨ诊断及预后判断方面有重要价值。

Objective: To study the relationship between CT grading and prognosis of intraventricular hemorrhage (IVH) in neonates. Metods:60 cases of IVH in neonates were diagnosed by CT, including 19 cases of preterm infants and 41 cases of term infants. The first CT scanning of head was performed within 1 week after birth and rescanned 1 month later. Result: There were lateral IVH (n = 59),lateral and third ventricle IVH (n=1),parenchyma hemorrhage (n= 11) as well as moderate lateral ventricle dilation (n= 11) and acute obstructive hydrocephalus (n =4) . According to accompanying with lateral ventricle dilation or not, IVH in neonates was divided in 3 grades:grade Ⅰ,that is pure IVH (n=45);grade Ⅱ ,IVH with lateral veniricle dilation (n=10);grade Ⅲ ,IVH with lateral ventricle di- lation and parenchyma hemorrhage (n =5) . The CT follow-up in 5 cases of grade Ⅰ demonstrated moderate lateral ventricle dilation; in 9 cases of grade Ⅱ moderate lateral ventricle dilation(n = 5) and obstructive hydrocephalus(n = 4) ;moderate lateral ventricle dilation (n = 1),obstructive hydrocephalus (n=3),cerebral atrophy (n=3) and encephalomalacia (n=4) in 5 cases of grade Ⅲ.Conclusion:IVH of grade Ⅰ might have a good prognosis, whereas the prognosis of IVH of grade Ⅱ and Ⅲ might be poor. Moreover, CT is an important method in diagnosis and evaluation of the prognosis of IVH in neonates.