颅脑超声在胎龄<32周VLBWI脑损伤中的应用分析

The Application of craniocerebral ultrasound in the brain injury of VLBWI premature infants less than 32 gestational weeks

目的:总结超声检查图像特征,探讨颅脑超声在极低出生体质量儿(VLBWI)脑损伤诊断中的诊断价值。方法:以我院2015年6月至2019年2月收治的符合纳入标准的162例VLBWI作为研究对象,详细记录临床表现,同时行颅脑超声检查,了解VLBWI颅脑发育成熟度及有无颅脑损伤,对于有颅脑损伤患儿进一步行磁共振成像(MRI),结果与颅脑超声对比。结果:本研究162例VLBWI颅脑超声检查中未发现异常42例(25.9%),脑室内出血73例(45.1%);蛛网膜下腔出血2例(1.20%);硬膜下出血3例(1.90%);小脑出血8例(4.94%);脑室扩大31例(19.1%),其中包括脑室出血合并脑室扩张13例(8.02%);脑白质损伤共16例(9.90%);院内及出院后死亡早产儿共41例(25.3%);发生脑损伤,临床各症状发生率会随之增加。结论:颅脑超声可直接在新生儿保温箱边操作,且无需使用镇静药物、无侵入性、无损伤、可重复性强,为临床早期诊断及干预VLBWI脑损伤提供依据,是VLBWI颅脑病变筛查的首选诊断方法。但对蛛网膜下腔与硬脑膜下出血探查存在一定局限性,需联合MRI检查。

Objective Investigated the application value of craniocerebral ultrasound in the diagnosis of the brain injury of very low birth weight infant(VLBWI)and premature infant less than 32 gestational weeks.Methods Selected 162 VLBWI from the preterm infants admitted in our hospital from June 2015 to February 2019,gave the patients magnetic resonance imaging(MRI)and brain ultrasound,understood the characteristics of craniocerebral maturation and traumatic brain injury in premature infants with VLBWI,and compared the results of brain ultrasound and MRI.Results Among the 162 patients with ultrasound examination,42 cases with no abnormality(25.9%);73 cases of intraventricular hemorrhage(45.1%);31 cases of ventricle enlarge(19.1%);16 cases suffered from purely white matter lesions(9.9%);41 premature dead before and after the hospitalized(25.3%).The incidence of clinical symptoms will increase accordingly with brain injury occurred.Conclusion The cranial ultrasound can be operated directly at the bedside without invasion or injury,provide basis for early diagnosis and intervention of brain injury in premature infants with VLBWI.However,there are some limitations in the exploration of subarachnoid hemorrhage and subdural hemorrhage.If necessary,MRI should be selected to assist in the diagnosis so as to avoid missed diagnosis.