颅脑超声在新生儿缺氧缺血性脑病诊疗中的临床应用价值

Clinical Application Value of Brain Ultrasound in the Diagnosis and Treatment of Neonatal Hypoxic Ischemic Encephalopathy

目的探讨对新生儿HIE(缺氧缺血性脑病)患者实施颅脑超声检测的临床价值。方法选择该院2016年3月-2019年2月收治的100例新生儿缺氧缺血性脑病患者作为实验对象;其中包括60例足月儿以及40例早产儿。将前囟作为声窗,于临床对其展开MCA(大脑中动脉)多普勒超声检查操作以及二维超声检查操作,并且同MRI检查结果以及CT检查结果进行对比。结果对于新生儿缺氧缺血性脑病患者完成头颅超声诊断后发现,60例足月儿中,脑水肿患者32例,脑白质病变患者4例,合并Ⅰ度颅内出血患者6例,Ⅱ度颅内出血患者14例,Ⅲ度颅内出血患者2例,Ⅳ度颅内出血患者2例;40例早产儿中,脑水肿患者10例,脑白质病变患者18例,合并Ⅰ度颅内出血患者6例,Ⅱ度颅内出血患者2例,Ⅲ度颅内出血患者2例,Ⅳ度颅内出血患者2例;总计脑水肿患者42例,脑白质病变患者22例,合并Ⅰ度颅内出血患者12例,Ⅱ度颅内出血患者16例,Ⅲ度颅内出血患者4例,Ⅳ度颅内出血患者4例;对于新生儿缺氧缺血性脑病患者完成二维超声检查后发现,均表现出程度不同的异常表现,合并或者未合并表现出RI(大脑中动脉阻力指数)异常的现象。对于足月儿患者,主要表现出脑水肿症状;对于早产儿主要表现出白质病变症状;同MRI以及CT诊断方法比较,颅脑超声表现出的吻合度较高。结论针对新生儿HIE患者于临床实施颅脑超声检查,对于患者侧脑室变化以及颅内结构变化可以进行充分显示,通过对二维图像进行分析,针对新生儿HIE脑损伤类型以及位置可以有效明确,配合MCA多普勒超声对患儿实施疾病诊断,可以将疾病早期诊断效果显著提升,并且可以做到动态观察患儿呈现出的脑损伤演变过程。

Objective To investigate the clinical value of cranial ultrasound in patients with neonatal HIE(hypoxic ischemic encephalopathy). Methods One hundred patients with neonatal hypoxic ischemic encephalopathy admitted to our hospital from March 2016 to February 2019 were enrolled in the study;including 60 full-term infants and 40 preterm infants. The anterior iliac crest was used as a sound window to perform MCA(brain middle cerebral artery)Doppler ultrasonography operation and two-dimensional ultrasonography operation in clinical practice, and compared with MRI examination results and CT examination results. Results After completing the diagnosis of neonatal hypoxic ischemic encephalopathy, 60 cases of full-term infants, 32 cases of cerebral edema, 4 cases of white matter lesions, and6 cases of intracranial hemorrhage with grade I, II degree 14 patients with intracranial hemorrhage, 2 patients with grade III intracranial hemorrhage, and 2 patients with IV intracranial hemorrhage. Among 40 premature infants, 10 patients had cerebral edema, 18 patients with white matter lesions, and 6 patients with intracranial hemorrhage. 2 patients with grade II intracranial hemorrhage, 2 patients with grade III intracranial hemorrhage, 2 patients with grade IV intracranial hemorrhage;42 patients with total cerebral edema, 22 patients with white matter lesions, 12 patients with intracranial hemorrhage, and 12 degree cranial There were 16 patients with internal hemorrhage, 4 patients with grade III intracranial hemorrhage, and 4 patients with grade IV intracranial hemorrhage. For patients with neonatal hypoxic ischemic encephalopathy, two-dimensional ultrasonography was performed and found to have different degrees of abnormal performance, combined or Uncombined showed an abnormality in RI(brain middle artery resistance index).For term infants, the symptoms of cerebral edema are mainly manifested;for premature infants, the symptoms of white matter lesions are mainly manifested;compared with MRI and CT diagnosis methods, the brain ultrasound shows a high degree of coincidence. Conclusion For the newborn patients with HIE, the clinical implementation of cranial ultrasound examination can fully display the changes of the lateral ventricle and intracranial structure of the patient. By analyzing the two-dimensional image, the type and location of the HIE brain injury can be effectively defined. In combination with MCA Doppler ultrasound to diagnose the disease in children, the early diagnosis of the disease can be significantly improved, and the evolution of brain damage exhibited by the child can be dynamically observed.