新生儿缺氧缺血性脑病CT诊断特点与临床表现分析

Analysis of CT Diagnostic Features and Clinical Manifestations of Neonatal Hypoxic Ischemic Encephalopathy

目的探析新生儿缺氧缺血性脑病的CT诊断特点及临床表现。方法以我院产科2014年1月-2015年7月出生37例缺氧缺血性脑病新生儿进行研究,均于患儿出生2周内行CT检查。将临床分度结果与CT分度结果进行比较,总结HIE的CT征象特点。结果 37例患儿中,临床分度结果为11例轻度、21例中度、5例重度,CT分度结果为2例正常、9例轻度、20例中度、7例重度,轻度、中度、重度的诊断准确性分别为77.8%(7/9)、80.0%(16/20)、71.4%(5/7)。CT征象表现为不同程度脑水肿,CT表现为大脑半球脑白质出现散在分布的低密度灶。CT值在16-20Hu之间,边界模糊不清。结论 HIE临床表现以过度兴奋、原始反射活跃、肌张力改变、嗜睡、失去正醒觉睡眠周期、瞳孔缩小等为主,CT检查可明确HIE病变部位、范围及颅内出血情况,掌握疾病严重程度以评估病情,且通过随访评估其预后及转归,在HIE临床诊断与治疗均发挥重要作用。

Objective To explore the CT diagnostic features and clinical manifestations of neonatal hypoxic ischemic encephalopathy.Methods 37 cases of newborns with hypoxic ischemic encephalopathy who were born in the obstetrical department of our hospital during January 2014 to July 2015 were taken as the research objects. All the newborns received CT examination in postnatal 2 weeks. The results of clinical graduation were compared with the results of CT graduation and the CT imaging features of HIE were summarized.Results Among the 37 cases, the results of clinical graduation were mild in 11 cases, moderate in 21 cases and severe in 5 cases. The results of CT graduation were normal in 2 cases, mild in 9 cases, moderate in 20 cases and severe in 7 cases. The diagnostic accuracy of mild, moderate and severe were 77.8% （7/9）, 80.0% （16/20） and 71.4% （5/7）, respectively. CT manifested as diffused distribution of low density lesions in cerebral hemisphere white matter. CT value was between 16 - 20Hu and the boundaries were blurred.Conclusion The clinical manifestations of HIE are hyperexcitability, active primitive reflex, changes of muscular tension, drowsiness, loss of normal wake-sleep cycle and miosis, et al. CT examination can clearly identify the location and extent of HIE lesions and the condition of intracranial hemorrhage. It can grasp the severity of the disease to evaluate the pathogenetic condition. Through follow-up, the prognosis and outcome are evaluated, which plays an important role in clinical diagnosis and treatment.