新生儿颅内出血的早期诊断和治疗探讨

TO EXPLORE THE EARLY DIAGNOSIS AND TREATMENT OF NEONATAL INTRACRANIAL HEMORRHAGE

为了降低新生儿颅内出血的病死率与伤残率 ,对 1 998年 1 0月～ 1 999年 3月具有窒息、异常分娩、产前产时并发症者的患儿生后 3～ 7天 3 7例行颅脑超声检查、63例行头颅CT检查。 1 0 0例中 <3 7周 3 2例。结果显示 :1 SAH 60例 (61 0 %) ,SEH -IVH 3 4例 (3 4 0 %) ,IPH 3例 (3 0 %) ,SDH 1例 (1 %) ;2 出生体重 <2 50 0g者SEH -IVH明显高于≥ 2 50 0g而SAH≥ 2 50 0g者明显高于 <2 50 0g。χ2 分别为3 9 62 8,2 6 789。P <0 0 1 ;3 不同类型ICH的临床表现SEH -IVH以抑制青紫为主 ,而SAH以兴奋为主。因此建议 ,对具有高危因素的患儿常规作床边颅脑超声 ,病情稳定者作CT检查可以及早发现ICH ,对IVHⅢ～Ⅳ级患儿可考虑连续腰椎穿刺放脑脊液以减少脑积水的发生。

In order to reduce the mortality and morbidity of neonatal intracranial hemorrhage (ICH), we explored the early diagnosis and treatment of ICH. From 1998. 10 to 1993. 3, 100 cases, 32 premature infants and 68 full-term infants, with high risk factors such as asphyxia, abnormal labor, complications before and during partam were examined. Thirty-seven cases were examined with ultrasound and 63 cases with cranial CT at age of 3 to 7 days. Result: 1. Subarachnoid hemorrhage (SAH) occured in 60 cases (61.2%), subependymal hemorrhage-intraventricular hemorrhage (SEH-IVH) or periventricular hemorrhage (PVH)-IVH in 34 cases (34.7%), Subdural hemorrhage (SDH) in 1 case (1.0%) and intraparenchymal hemorrhage in 3 cases (3.1%). 2. The incidence of SEH-IVH was higher in infants with birth weight less than 2500g, while SAH was more common in infants with birth weight higher than 2500g (P<0.01). 3. The clinical symptoms and main signs of the SEH-IVH were inhibition, cyanosis, while SAH patients showed more irritable, χ 2=9.851, P<0.001. Abnormal reflexes and myobradia were the main signs in ICH. We suggest to examine with intracranial ultrasound and CT intracranial scan at 3～7 day after birth to make early diagnosis of neonatal ICH when babies had high risk factors. Serial lumbar punctures could reduce the neonatal posthemorrhagic hydrocephalus.