宫内感染与脑损伤122例临床分析

Clinical Features with Intrauterine Infection and Brain Injury in 122 Cases

目的探讨宫内感染类型及其与患儿脑损伤关系。方法回顾性分析我院2008年8月至2013年8月出院诊断先天性感染的122例病历资料,并随访患儿神经系统损伤表现,分析神经系统损伤发生概率及类型。结果 122例中早产儿44例(36.1%),低出生体重儿38例(31.1%);单纯先天性梅毒感染69例(56.6%)、病毒感染14例(11.5%)、细菌感染11例(9.0%),结核感染1例(0.8%),混合感染18例(14.7%),病原菌不明确9例(7.4%)。50例有影像学检查中41例有异常改变,主要表现为颅内出血及脑实质密度减低。共随访100例(随访率82.0%),死亡24例(24.0%),平均随访时间(32.0±16.7)个月,未见明显异常59例(59.0%),发生神经系统后遗症17例(17%)。结论先天性梅毒感染在宫内感染中占较大比例,宫内感染死亡率较高,大部分存活患儿未出现明显神经系统后遗症,部分存在明显语言、运动发育障碍、脑瘫、癫痫等表现,需定期随访神经系统发育情况,必要时早期康复治疗。

Objective To explore the types of intrauterine infection and the brain injury in newborns. Methods A retro- spective analysis of 122 newborns diagnosed with congenital infection in our hospital from August 2008 to August 2013 was carried out. The neurological performance and injury was also analyzed in follow-ups. Results Among the 122 newborns, 44 （36. 1% ） were preterm, and 38 （31.1%） were low birth weight. Intrauterine infection was identified with simple congenital syphilis 69cases （ 56. 6% ）, viral infection 14 cases （ 11.5% ）, other bacterial infection 11 cases （ 9.0% ） , tuberculosis 1 case （0. 8% ） , combined infection in 18 cases（14.7% ）, and unknown 9 cases （7.4%）. Lesion was found in 41 cases out of 50 chil- dren with B-ultrasound, CT, or MRI, which was mostly in the form of intracranial hemorrhage or parenchymal density secrease. 100 children （82. 0% ） were followed up with a mean term of32. 0 ± 16. 7 months, including 59 （59.0%） with no obvious abnor- malities, 17 （17%）with neurological sequelae, and 24 （24. 0% ） died. Conclusion According to this clinical series, congenital syphilis is the most common type of intrauterine infection among newborns. The mortality rate of intrauterine infection is relatively high. No obvious neurological disorder is detected among the majority of surviving infants, but some sequence is also detected, such as language and/or motor develop disorders, cerebral palsy, epilepsy, and so on. Regular follow-up of nervous system devel-opment is needed and early rehabilitation is urgent in ease.