颅脑三维超声评价新生儿定量分析颅内出血量的临床价值

Clinical value of quantitative evaluation of intracranial hemorrhage in neonates by three-dimensional ultrasonography

目的:研究颅脑三维超声在新生儿定量分析颅内出血量的可行性和准确性及患儿预后影响的临床价值。方法:2015年1月—2017年2月疑为存在颅内出血的187例新生儿,进行颅内超声初筛,同时进行颅脑CT确诊,诊断结果为所有新生儿均存在不同程度的颅内出血现象。分别采用脑部CT、三维超声检查新生儿的颅内出血情况,通过比较分析三维超声检查在定量分析新生儿颅内出血量的可行性和准确性。结果:经CT确诊检查,结合出血量的Papile分级标准,新生儿的出血情况分级结果为Ⅰ级51例,Ⅱ级53例,Ⅲ级62例,Ⅳ级21例;三维超声诊断结果为Ⅰ级54例,Ⅱ级49例,Ⅲ级65例,Ⅳ级19例,与CT的确诊检查结果无明显差异,不具有统计学意义(P>0.05)。在对新生儿颅内出血的准确度检测中,室管膜下出血、脑室内出血、硬脑膜下出血、蛛网膜下腔出血以及脑实质出血的CT检查准确度分别为47.33%、31.24%、94.62%、91.73%、91.35%,三维超声分别为98.74%、96.37%、91.51%、90.41%、97.64,三维超声检查在室管膜下出血、脑室内出血以及脑实质出血的准确度明显优于CT检查,差异具有统计学意义(P<0.05)。结论:颅脑三维超声在对新生儿颅内出血量的定量分析中具有较高的可行性和准确性,对新生儿的预后判断具有较大的指导意义,临床应用价值较高,值得推广。

Objective： To study the feasibility and accuracy of brain three-dimensional ultrasonography in quantitative analysis of intracranial hemorrhage in neonates and its influence on prognosis. Methods： One hundred and eighty-seven neonates born in our hospital suspected of symptomatic intracranial hemorrhage from January 2015 to February 2017 were selected retrospectively. All of the neonates were screened by intracranial ultrasonography and confirmed of intracranial hemorrhage of different levels by brain CT examination. Quantitative analysis of neonatal intracranial hemorrhage was compared between the two examinations. Result： According to the result of CT and Papile grading standards, there were 51 cases of gradeⅠ, 53 cases of grade Ⅱ, 62 cases of grade Ⅲ and 21 cases of grade Ⅳ. According to the result of three-dimensional ultrasonography, there were 54 cases of grade Ⅰ, 49 cases of grade Ⅱ, 65 cases of grade Ⅲ and 19 cases of grade Ⅳ. There was no significant difference between the results of CT and three-dimensional ultrasonography. The diagnosis accuracy of subependymal hemorrhage, intraventricular hemorrhage, subdural hemorrhage, subarachnoid hemorrhage and intraparenchymal hemorrhage were 47.33%, 31.24%, 94.62%, 91.73% and 91.35% by CT, and 98.74%, 96.37%, 91.51%, 90.41%, 97.64 by three-dimensional ultrasonography, with significant difference（P〈0.05）. Conclusion： Three-dimensional brain ultrasonography has a high feasibility and accuracy in quantitative analysis of intracranial hemorrhage in neonates, and it has a great significance for the prognosis.