胎儿期脑损伤的发生与预后研究

Brain Damages in Utero -- Their Development and Prognosis

目的 更好地认识胎儿期发生的脑损伤 ,为临床治疗及早期干预提供依据。方法 分析 115例确诊为胎儿期脑损伤患儿的脑损伤类型 ,及其与脑损伤可能有关的妊娠期高危因素及新生儿的异常征象 ,以及脑损伤程度与高危因素和神经系统症状、体征的关系。通过随访了解脑损伤患儿的预后。结果 115例存在胎儿期脑损伤的患儿中 ,不同部位颅内出血 71例 (6 1.7% ) ,双侧脑半球实质性病变 4 4例 (38.3% )。 6 4例 (5 5 .6 % )存在妊娠期多种合并症 ,34例 (2 9.6 % )新生儿期表现出惊厥、肌张力异常或激惹状态。脑损伤程度与妊娠期高危因素有无及新生儿神经系统症状、体征存在与否有关。对 5 5例患儿随访结果显示 ,16例 (2 9.1% )遗留有神经系统异常 ,主要发生在重度脑损伤组。结论 对胎儿期发生的脑损伤应予以充分注意 ,及时通过影像学检查确诊 。

Objective To study the characteristics of brain damages in utero in order to establish more effective treatment. Methods Clinical data of 115 neonates with brain damages which developed in utero were studied retrospectively: types of brain damages, high risk factors associated with brain damages, relationship between the degree of brain damages and high risk factors and neurological signs. Follow up was done to observe the prognosis in survivals. Results Of the 115 patients, 71 ( 61.7% ) had intracranial hemorrhage and 44 ( 38.3% ) showed cerebral parenchyma lesions; 64 ( 55.6% ) had high risk factors associated with brain damages; 34 ( 29.6% ) had abnormal neurological signs: convulsion, hypertonia or irritability. The degree of brain damages was correlated with the high risk factors and neonatal neurological signs. Of the 55 follow up patients, 16 ( 29.1% ) had neurological sequels. Conclusions It is necessary to understand the characteristics of brain damages which develop in utero to enable early diagnosis and intervention and to improve the survival rate and prognosis.