颅脑超声对围生期窒息患儿脑损伤的诊断价值

Diagnostic value of craniocerebral ultrasound for brain injury in children with perinatal asphyxia

目的探讨床旁颅脑超声检查在围生期窒息患儿脑损伤中的诊断价值。方法选取2015年7月至2017年7月出生且有围生期窒息病史的118例患儿为研究对象，均在出生72 h内行首次颅脑超声检查，检测患儿大脑前动脉以及大脑中动脉的血流动力学情况。结果118例患儿中90例表现出不同程度的脑损伤，超声检查阳性率为76.3%（90/118），其中脑水肿24例，颅内出血45例，脑白质损伤19例，丘脑基底核损伤2例。以MRI诊断为标准，其中7例单发或伴发蛛网膜下腔出血、硬膜下出血患儿和4例脑实质点状出血患儿未能经超声检出，假阴性率为9.3%；6例顶叶、额局限性脑水肿患儿未经超声检出，假阴性率为5.1%。早产儿颅内出血、脑白质损伤的发生率高于足月儿，而足月儿脑水肿的发生率高于早产儿（P〈0.05）；早产儿与足月儿在血流动力学改变发生方面比较差异未见统计学意义（P〉0.05）。胎龄越小，新生儿颅内出血、脑白质损伤的发生概率越高，各胎龄组患儿颅内出血、脑白质损伤发生率比较差异有统计学意义（P〈0.05）；而不同胎龄组血流动力学改变、脑水肿发生率比较差异未见统计学意义（P〉0.05）。结论围生期窒息患儿易引发颅脑损伤，颅脑超声检测能够检出患儿脑组织结构的变化，发现脑血流动力学改变，对临床早期做出干预措施、改善预后有重要临床价值。

Objective To investigate the diagnostic value of bedside craniocerebral ultrasonogra- phy for brain injury of children with perinatal asphyxia. Methods A total of 118 children who were born in July 2015 to July 2017 with perinatal asphyxia were selected as research subjects. The first craniocere- bral ultrasound examination was performed within 72 hours after childbirth, and the hemodynamics of the anterior cerebral artery and the middle cerebral artery were detected. Results Of the 118 cases, 90 ca- ses showed brain injury with different degrees. （90/118 ） , including 24 cases of cerebral edema, matter lesions, and 2 cases of thalamic basal The positive rate of uhrasonography was 76.3% 45 cases of intracranial hemorrhage, 19 cases of white ganglia injury. The resuhs of magnetic resonance imaging （MRI） were considered as the diagnostic standard, and 7 cases of solitary subarachnoid hemorrhage or associated with subdural hemorrhage, 4 cases of brain parenchyma punctate hemorrhage were missed by ultrasound diagnosis, with the false negative rate bral edema were not checked out by ultrasound, of 9. 3% ; 6 cases of parietal lobe and frontal focal cere- with the false negative rate of 5.1%. The incidence of intracranial hemorrhage and white matter injury in preterm infants was higher than that in full-term in- fants, but the incidence of brain edema in full-term infants was higher than that in preterm infants, the difference was statistically significant （ P 〈 0. 05 ）. There was no significant difference in hemodynamics between preterm infants and full-term infants （ P 〉 0. 05 ）. The smaller the gestational age, the higher the incidence of intracranial hemorrhage and brain white matter injury in the newborns, there was a signifi- cant difference in the incidence of intracranial hemorrhage and brain white matter injury among children in different age groups （ P 〈 0. 05 ）. There was no significant difference in the hemodynamics changes andthe incidence of brain edema among different gestational age groups （P 〉 0. 05）. Conclusions Perina- tal asphyxia in children can cause brain injury easily, brain ultrasound could find brain tissue structure changes, and found changes in cerebral hemodynamics, which has significance in early intervention and improvement on prognosis in clinical.