12例新生儿脑梗死的临床特点分析

Analysis of clinical features in 12 cases with neonatal cerebral infarction

目的:探讨新生儿脑梗死的危险因素、临床特点、治疗及预后。方法:回顾性分析2018年1月至2021年3月某医院收治的12例新生儿脑梗死患儿的临床资料。结果:首发症状抽搐10例,其中单侧肢体6例,双侧肢体4例;首发症状发作性青紫1例;无症状1例;有首发症状的患儿发病时间均在生后5 d内,最早1例生后8 h即出现症状。围生期高危因素:围生期缺氧窒息7例,妊娠期高血压4例,新生儿感染2例,血管发育异常1例。所有患儿均接受头颅超声(CBU)和头颅磁共振(MRI)检查,其中动脉缺血性脑梗死10例,8例梗塞位于大脑中动脉分支或主干梗塞,2例位于大脑后动脉分支;出血性脑梗死2例,均为脑室旁静脉出血梗塞;10例为单纯左侧脑梗死,其余2例为双侧脑梗死。结局:9例治愈,2例好转,其中1例因反复惊厥,家属因个人原因放弃治疗,后期失访。结论:新生儿脑梗死常见危险因素为围产期缺氧、妊娠期高血压、新生儿感染、血管发育异常等,临床上多以发作抽搐为首要症状,左侧脑梗死多见,常累及大脑中动脉分支或主干,多有不同程度的神经系统后遗症。因此,早识别、早治疗能很大程度地改善预后。

Objective: To investigate the risk factors, clinical features, treatment and prognosis of neonatal cerebral infarction. Methods: The clinical data of 12 neonates with cerebral infarction admitted to one hospital from January 2018 to March 2021 were retrospectively analyzed. Results: In this study, the 12 children with neonatal cerebral infarction were treated, including 8 males and 4 females;1 preterm infant and 11 term infants;6 normal births and 6 cesarean sections. The first symptoms includeded convulsions(10 cases), which comprised 6 unilateral limbs and 4 bilateral limbs, paroxysmal bruising(1 case) and asymptomatic(1case). The onset time was all within 5 days, and the earliest case showed symptoms at 8 hours after birth. The risk factors includedperinatal hypoxia(7 cases), hypertension during pregnancy(4 cases), infant infection(2 cases) and vascular dysplasia(1 case). All children underwent cranial ultrasound(CBU) and cranial magnetic resonance(MRI) examinations. There were 10 cases of ischemic cerebral infarction and 2 cases of hemorrhagic cerebral infarction;10 cases of left cerebral infarction and 2 cases of bilateral cerebral infarction. Among the 10 cases of ischemic cerebral infarction, 8 cases occured in the branch or trunk of the middle cerebral artery and 2 cases were located in the branch of the posterior cerebral artery. Hemorrhagic cerebral infarction was all caused by paraventricular venous hemorrhage. Finally, 9 cases were cured, 2 cases improved, and 1 case was released halfway due to repeated convulsions. Conclusion: The common risk factors of neonatal cerebral infarction are perinatal hypoxia, pregnancy-induced hypertension, neonatal infection, vascular dysplasia, etc. Clinically, convulsions are the primary symptom andleft cerebral infarction is more common, with the branches or trunk of the middle cerebral artery often damaged. The disease usually leads to varying degrees of neurological sequelae. Therefore, early recognition and early treatment can greatly improve the prognosis.