新生儿脑积水病因特点及治疗结局的研究

Hydrocephalus in newborn characteristics and prognosis

目的探讨新生儿期发生脑积水患儿的临床特点和病因，比较不同病因脑积水的治疗方法及结局。方法收集我院2011年9月至2015年6月住院治疗并在新生儿期发病的脑积水患儿临床资料，记录患儿一般情况、影像学检查结果、治疗方法及疗效。出院后3～6个月对患儿进行随访，比较不同病因所致脑积水对不同治疗方法的疗效和结局，并对足月儿和早产儿脑积水发病原因及治疗方法进行回顾性分析。结果共纳入脑积水患儿38例，其中早产儿23例（60．5％），足月儿15例（39．5％）。脑积水病因中颅内出血18例（47．4％），颅内感染11例（28．9％），颅内出血合并颅内感染8例（21．1％），甲基丙二酸尿症合并同型半胱氨酸血症1例（2．6％）。足月儿与早产儿脑积水病因比较差异无统计学意义（P〉0．05）。14例颅内出血后脑积水患儿通过连续腰穿、脑室外引流、脑室储液囊反复放液治愈。颅内出血合并颅内感染后脑积水和颅内感染后脑积水患儿分别为9例和6例，最终需行永久分流术；这两种病因引起的脑积水患儿行永久分流术比例明显高于单纯颅内出血患儿（P〈0．05）。出院后37例（97．4％）脑积水患儿无复发，16例（42．1％）存在不同程度的神经系统后遗症。结论颅内出血和颅内感染是新生儿脑积水的主要病因，单纯颅内出血后脑积水较少需行永久分流术治疗。即使患儿脑积水缓解，也很有可能存在神经系统后遗症。

Objective To study the clinical and etiological characteristics of the newborn with hydrocephalus, and to compare the treatment methods and outcomes for hydrocephalus with different causes. Methods Neonatal onset of hydrocephalus cases admitted to neonatal ward of our Hospital from September, 2011 to June, 2015 were retrospectively enrolled for study. Data of demographic characteristics, cranial imaging findings, treatment methods and efficacy of therapy of these patients were collected. Infants enrolled in this study were followed up after three to six month of discharge from hospital. Response and outcome of different treatment for hydrocephalus with different etiologies were compared. The causes of hydrocephalus and the treatment methods were also compared between term and preterm infants. Results A total of 38 cases of hydrocephalus were enrolled, of which 23 cases were premature infants （ 60. 5% ） , 15 cases were term infants （39. 5% ）. Etiologies among our cohort were intracranial hemorrhage （ 18/38, 47.4% ） , central nervous system infection （11/38, 28.9% ）, intracranial hemorrhage complicated with central nervous system infection （ 8/38, 21.1% ）, and inborn error of metabolism （ methylmalonic aciduria and hyperhomocysteinemia） （ 1/38, 2. 6% ）. Etiological spectrum of hydrocephalus between preterm infants and term infant were of no significant difference statistically （ P 〉 0. 05 ）. The majority （ 14/18, 77.8% ） of hydrocephalus following intracranial hemorrhage were treated by intermittent lumbar puncture, external drainage of ventricles, liquid storage sac of ventricle and recovered. Among infants with intracranial hemorrhage plus central nervous system infection and infants with central nervous system infection without hemorrhage, majority （9/11 and 6/8 respectively） finally received permanent shunt （ventriculo-peritoneal shunt）. Percentage of shunt in hydrocephalic infants with central nervous system infection was significantly higher than that in infants with intracranial hemorrhage alone （ P 〈 0.05 ） . After hospital discharge, 37 （97.4%） infants had no recurrence of hydrocephalus, whereas 16 （42. 1% ） infants had varying degrees of neurological sequelae. Conclusion Intracranial hemorrhage and central nervous system infection are the common causes of hydrocephalus. Majority of hydrocephalus patients who without intracranial hemorrhage do not need permanent shunt treatment. However, nearly half of the infants have neurological sequelae even after the hydrocephalus has recovered.