脑室帽状腱膜下引流术治疗早产儿脑室内出血后脑积水的疗效分析

Effect of ventriculosubgaleal shunts in the treatment of posthemorrhagic hydrocephalus of preterm infants

目的 探讨脑室帽状腱膜下(ventriculosubgaleal, VSG)引流术治疗早产儿脑室内出血后脑积水的安全性、可行性。方法 以2012年11月至2019年11月北京大学第三医院新生儿重症监护病房收治的脑室帽状腱膜下引流的脑室内出血后脑积水早产儿为研究对象。比较VSG引流术治疗前后患儿脑脊液蛋白、细胞数、头围变化情况。本组5例早产儿,胎龄(29.36±3.43)周;出生体重(1 560.00±665.85)g。行VSG时日龄9~39 d,中位数30(15,36)d。5例均为脑室内出血继发梗阻性脑积水;围产期并发疾病包括:窒息2例,新生儿呼吸窘迫综合征3例,动脉导管未闭4例,持续肺动脉高压3例,败血症1例,呼吸性酸中毒5例。结果 5例患儿共进行6次VSG分流术。6次置管过程顺利,VSG引流持续时间1~18个月,中位数8.75(4~17.25)个月。与VSG引流术前相比,患儿治疗后脑脊液蛋白水平逐渐下降[(14 152.67±10 857.27)/μL比(744.00±501.86)/μL],脑脊液细胞数及头围监测数值均较治疗前下降[(29.43±4.12)cm比(27.67±3.71)cm]。术后帽状腱膜下囊暂时性关闭1例,经调整位置后再次应用;堵管1例;无一例导管相关感染等其他并发症。5例均存活,1例中度智力低下,1例轻度智力低下,3例发育正常。结论 VSG引流术治疗早产儿脑室内出血后脑积水安全可行,能改善患儿预后,提高生存率,并发症较少且可控。

Objective To explore the complications and clinical outcomes of ventriculosubgaleal(VSG)shunt in the treatment of posthemorrhagic hydrocephalus of preterm infants.Methods From November 2012 to November 2019,clinical data were retrospectively reviewed for 5 premature infants with posthemorrhagic hydrocephalus undergoing VSG shunt in neonatal intensive care unit.The changes of cerebrospinal fluid(CSF)protein,cell number and head circumference pre/post-VSG drainage were compared.The gestational age was(29.36±3.43)weeks and birth weight(1 560.00±665.85)grams.The operative age of VSG was(9-39)days with a median of 30(15-36)days.All etiologies were obstructive hydrocephalus secondary to intraventricular hemorrhage;Perinatal complications included asphyxia(n=2)and neonatal respiratory distress syndrome(n=3).There were patent ductus arteriosus(n=4),persistent pulmonary hypertension(n=3),septicemia(n=1)and respiratory acidosis(n=5).Results VSG shunt was performed 6 times.The duration of VSG drainage was(1-18)months with a median of 8.75(4-17.25)months.Compared with pre-VSG drainage,protein level of CSF declined gradually,count of CSF cells and head circumference decreased significantly.One case of temporary closure was re-operated after position adjusting.One case was blocked and no catheter-related infection or other complications occurred.During follow-ups,all of them survived.The outcomes were moderate mental retardation(n=1),mild mental retardation(n=1)and normal development(n=3).Conclusion VSG shunt is both safe and effective for premature hydrocephalus.Economical and convenient,it improves the prognosis and survival rate of children.The complications are fewer and controllable.