新生儿脑梗死39例病例分析

Clinical analysis of 39 cases with neonatal cerebral infarction

目的探讨新生儿脑梗死(NCI)的临床特点、发病机制、诊疗及预后,以进一步加深对该病的认识,提高临床疗效并改善预后。方法对高州市人民医院和汕头大学医学院第二附属医院新生儿科2013年1月至2018年3月收治的39例NCI患儿的临床病史、头颅磁共振成像(MRI)+磁共振弥散加权成像(DWI)资料及随访结果进行回顾性分析。结果入选39例患儿均通过MRI+DWI检查诊断为NCI,其中足月儿30例(76.92%),早产儿9例(23.08%);男性患儿占61.54%(24/39例);17例(43.59%)因脐带绕颈、胎儿宫内窘迫、母亲妊娠期高血压等产科疾病行紧急剖宫产,25例(64.10%)存在围生期缺氧病史,32例(82.10%)为缺血性脑梗死,7例(17.90%)为出血性脑梗死。NCI最易累及大脑中动脉及其分支,且左侧较右侧多见。16例(41.03%)患儿出现惊厥症状。39例患儿中死亡2例,均为细菌性脑膜脑炎并NCI,1例在新生儿期放弃治疗,出院2 d后死亡,1例在11个月大时因脑性瘫痪、肺炎死亡。9例(31.03%)出现脑性瘫痪,2例能说话,但复杂语句无法表达。结论围生期缺氧、紧急剖宫产可能与NCI的发病密切相关。继发于细菌性脑膜脑炎的NCI病情更重,预后更差。NCI早期缺乏特异性临床表现,头颅MRI+DWI检查作为NCI诊断的金标准,可根据临床情况早期行头颅MRI+DWI检查,以协助早期诊断和干预。

Objective To investigate the clinical features, pathogenesis, diagnosis and treatment of neonatal cerebral infarction (NCI) in order to have a further understanding of its clinical features, to enhance therapeutic efficacy and to improve prognosis. Methods The clinical history, head magnetic resonance imaging(MRI)+ diffusion weighted imaging(DWI)data and follow-up results of 39 neonates with NCI admitted into the Department of Neonato-logy, Gaozhou People′s Hospital and the Second Affiliated Hospital of Shantou University Medical College from January 2013 to March 2018 were retrospectively analyzed. Results All the 39 children were diagnosed as NCI by MRI+ DWI, among which 30 cases(76.92%) were full-term infants, and 9 cases (23.08%) were premature infants, in which 61.54%(24/39 cases) were males, and 17 cases (43.59%) were performed with emergency cesarean section because of umbilical cord around neck, intrauterine distress or maternal pregnancy hypertension respectively.Twenty-five patients (64.10%) had the history of perinatal hypoxia.The presentation of MRI showed 32 cases (82.10%) of ischemic cerebral infarction and 7 cases (17.90%) of hemorrhagic cerebral infarction, while middle cerebral artery and its branches were more susceptible to NCI with a left hemisphere predominance.Sixteen patients (41.03%) developed convulsions.Two patients died of purulent meningoencephalitis associated with NCI.One patient gave up treatment in the neonatal period and died 2 days after discharge.One patient died of cerebral palsy and pneumonia at the age of 11 months. Nine cases (31.03%) developed cerebral palsy, and 2 patients developed speech disturbance so they could not express complex sentences. Conclusions Perinatal hypoxia and emergency cesarean section may be closely related to the incidence of NCI.NCI resulting from purulent meningoencephalitis is more severe and has a worse prognosis. Considering the facts that NCI usually does not have specific clinical manifestations in the early stage, MRI + DWI, as the gold standard for the diagnosis of NCI, could be performed to facilitate early diagnosis and intervention.