胎儿期侧脑室增宽新生儿生后神经发育的初步探讨

A preliminary study on the postnatal neurodevelopment of fetus with ventriculomegaly

目的 探讨胎儿期侧脑室增宽新生儿的神经预后及其影响因素.方法 选择2013年1月至2015年12月于本院新生儿科就诊、宫内即发现侧脑室增宽的患儿进行回顾性研究.所有患儿于生后1周内,3、6、9个月和1岁时行动态头颅超声监测,出生6个月后行格赛尔（Gesell）发育量表评估.应用x2检验、两独立样本t检验分析影响患儿神经预后的因素.结果 共纳入胎儿期侧脑室增宽患儿103例,其中侧脑室轻度增宽95例（92.2％）,重度增宽8例（7.8％）;合并畸形（非孤立性侧脑室增宽）3例（2.9％）,孤立性侧脑室增宽100例（97.1％）.83例于我院定期行头颅超声监测至生后6个月,存在侧脑室进行性增宽9例,稳定或恢复正常74例.出生6个月后完成Gesell发育量表评估65例,侧脑室进行性增宽的8例均预后不良（8/8）;未进展的57例中预后不良6例（10.5％）,差异有统计学意义（P＜0.001）.宫内侧脑室增宽程度与神经预后无关（P=1.000）.合并畸形的3例患儿中随访2例,其中1例预后不良.结论 胎儿期侧脑室增宽以轻度、孤立性侧脑室增宽为主,大多数患儿生后侧脑室保持稳定或逐渐恢复正常,生后侧脑室继续增宽者不良神经预后发生率高.

Objective To study the neurological prognosis of neonates with ventriculomegaly and its influencing factors.Method A retrospective study was conducted among neonates with ventriculomegaly in Peking University First Hospital from January 2013 to December 2015.A series of cranial ultrasonography were performed after birth and the Gesell development scale was conpleted after six months.x2 test and two-independent-sample t test were used for statistical analysis.Result Among 103 cases of ventriculomegaly,95 cases （92.2%） had mildly enlarged lateral ventricles and 8 cases （7.8%） significantly enlarged.83 cases received serial cranial ultrasound examinations after birth.The lateral ventricles of 9 patients （10.8%） bacame wider and 74 （89.2%） not.The Gesell development scales were completed in 65 cases 6 months after birth.Among them,8 patients with widening lateral ventricles got poor prognosis （100%）.Among 57 patients without progressively widening lateral ventricles,6 （10.5%） had poor prognosis.The difference was statistically significant （P 〈 0.001）.No correlation was found between the severity of the lateral ventricle widening and the neurological outcome （P =1.000）.There were 2 cases with other abnormalities,and 1 case got poor prognosis on follow-up.Conclusion Most neonatal ventriculomegaly patients have mild and isolated lateral ventricle enlargement.Most of them remain stable or gradually return to normal.The patients with progressively widening lateral ventricles are likely to have adverse neurological prognosis.