Endoscopic Surgery versus External Ventricular Drainage Surgery for Severe Intraventricular Hemorrhage

The efficacy and applied value of endoscopic hematoma evacuation vs. external ventricular drainage (EVD) in the treatment of severe ventficular hemorrhage (IVH) were explored and compared.From Jan.2015 to Dec.2016,the clinical data of 42 cases of IVH were retrospectively analyzed,including 18 patients undergoing endoscopic hematoma evacuation (group A),and 24patients receiving EVD (group B).The hematoma clearance rate was calculated by 3D Slicer software,and complications and outcomes were compared between the two groups.There were no significant differences in age,sex and Graeb score between groups A and B (P>0.05).The hematoma clearance rate was 70.81%±27.64% in group A and 48.72%±36.58% in group B with a statistically significant difference (P<0.05).The operative time in groups A and B was 72.45±25.26 min and 28.54±15.27min,respectively (P<0.05).The Glasgow Coma Scale (GCS) score increased from 9.28±2.72 at baseline to 11.83±2.91 at 1 week postoperatively in group A,and from 8.25±2.62 at baseline to 10.79±4.12 at 1 week postoperatively in group B (P<0.05).The length of hospital stay was 12.67±5.97 days in group A and 17.33±8.91 days in group B with a statistically significant difference (P<0.05).The GOS scores at 6 months after surgery were 3.83±1.12 in group A,and 2.75±1.23 in group B (P<0.05). These results suggested that endoscopic hematoma evacuation has an advantage of a higher hematoma clearance rate,fewer complications and better outcomes in the treatment of severe IVH,indicating it is a safe,effective and promising approach for severe IVH.

MODIFIED GRAEB CRITERIA FOR PREDICTING THE POST-HEMORRHAGIC HYDROCEPHALUS IN INTRAVENTRICULAR HEMORRHAGE

Objective To set up a new grading system of intraventricular hemorrhage (IVH) and determine the value of predicting the probability of post-hemorrhagic hydrocephalus (PHH) in IVH. Methods We first modified the Graeb criteria, then compared the value of prediction for PHH assessed by the Graeb criteria with the modified Graeb criteria. One hundred and thirty one IVH patients were divided into two groups: the upper group (n=67) and the lower group (n=64). Gold standard of PHH was assessed by CT scan or by out-drainage. The diagno-stic parameters such as sensitivity (SE), specificity (SP) were analyzed. In the cutoff point of SE and SP curves, diagnostic efficiency (DE), and Kappa value (K) were analyzed. The probability of PHH was estimated by binary logistic regressions. Results In all ventricular group, to Graeb criteria in the cutoff point, SE, SP, and K was 0.78, 0.84, and 0.60; and to modified Graeb criteria SE, SP, and K was 0.90, 0.84, and 0.74 respectively. The probability of PHH from point of 3-12 was 0.011, 0.032, 0.085, 0.212, 0.435, 0.689, 0.865, 0.949, 0.981, and 0.994 respectively according to modified Graeb criteria. Conclusion The modified Graeb criteria combined with logistic regression were useful methods to assess the severity of IVH and to predict the probability of PHH in IVH.

Adrenal Hemorrhage as a Rare Cause of Neonatal Anemia Associated with Hydrocephalus Secondary to Intraventricular Hemorrhage—A Case Report

Neonatal adrenal hemorrhage is frequently associated with birth trauma, perinatal asphyxia, intrauterine infection, coagulation defects and thromboembolism. It has varied clinical presentation depending on degree of hemorrhage and amount of adrenal cortex compromised by hemorrhage. The most common clinical presentations are persistent jaundice and flank mass. We report a case of left sided adrenal hemorrhage in a breech delivered male neonate with perinatal asphyxia presented with anemia and fever. On further evaluation, he was also having moderate communicating hydrocephalus secondary to intraventricular hemorrhage. The adrenal hemorrhage was managed conservatively. Subsequent abdominal ultrasound showed resolving adrenal hemorrhage. Right ventriculoperitoneal shunt was done for hydrocephalus. Postoperative course was uneventful. The patient is asymptomatic at follow-up.

Necrostatin-1 decreases necroptosis and inflammatory markers after intraventricular hemorrhage in mice

Necrostatin-1,an inhibitor of necroptosis,can effectively inhibit necrotic apoptosis in neurological diseases,which results in the inhibition of inflammation,endoplasmic reticulum stress,and reactive oxygen species production and substantial improvement of neurological function.However,the effects of necrostatin-1 on intraventricular hemorrhage(IVH)remain unknown.In this study,we established a mouse model of IVH by injecting autologous blood into the lateral ventricle of the brain.We also injected necrostatin-1 into the lateral ventricle one hour prior to IVH induction.We found that necrostatin-1 effectively reduced the expression levels of the necroptosis markers receptor-interacting protein kinase(RIP)1,RIP3,mixed lineage kinase domain-like protein(MLKL),phosphorylated(p)-RIP3,and p-MLKL and the levels of interleukin-1β,interleukin-6,and tumor necrosis factor-αin the surrounding areas of the lateral ventricle.However,necrostatin-1 did not reduce ependymal ciliary injury or brain water content.These findings suggest that necrostatin-1 can prevent local inflammation and microglial activation induced by IVH but does not greatly improve prognosis.

Endoscopic surgery for intraventricular hemorrhage:A comparative study and single center surgical experience

BACKGROUND Intraventricular hemorrhage is a neurosurgical emergency,and a dangerous condition associated with high morbidity and mortality.Previously,hematoma evacuation is generally executed by external intracranial drainage(EVD)or surgical evacuation.Nowadays,endoscopic evacuation is emerging as a good alternative because it brings relatively less invasion and injury.However,successful endoscopic evacuation requires skilled manipulation of endoscopic devices and the evidence supporting its efficacy differs in different reports.AIM To improve the technique usage and provide more evidence of endoscopic evacuation efficacy,we summarize our surgical experience and compared the outcomes of the endoscopic evacuation with EVD using real-world data.METHODS We retrospectively studied 96 consecutive patients with intraventricular hemorrhage who underwent either endoscopic surgery(n=43)or non-endoscopic surgery(n=53)for hemorrhage evacuation between November 2013 and September 2019 in our center.Patients’conditions prior to and after the operation were evaluated and analyzed to assess the efficacy of the operation.The consciousness status improvement and perioperative in-hospital parameters in the two types of operation groups were assessed and compared.RESULTS Patients in the endoscopic and non-endoscopic groups presented with a similar state of consciousness,with a comparable Glasgow Coma Scale(GCS)index.The average operation time of the endoscopic group was longer than that of the nonendoscopic group(median 2.42 h vs 1.08 h,P<0.001).Although the endoscopic group was older and had a baseline Graeb score that indicated more severe hemorrhage than the non-endoscopic group(Graeb median:Endoscopic group=9 vs non-endoscopic group=8,P=0.023),the clearance rate of hematoma was as high as 60.5%.Both the endoscopic and non-endoscopic groups showed an improved GCS index after surgery.However,this improvement was more marked in patients in the endoscopic group(median improvement of GCS index:Endoscope group=4 vs non-endoscopic group=1,P<0.001).Additionally,the endoscopic group had a lower Graeb score than the non-endoscopic group after the operation.The intensive care unit stay of the endoscopic group was significantly shorter than that of the non-endoscopic group(median:endoscopic group=6 d vs non-endoscope group=7 d,P=0.017).CONCLUSION Endoscopic evacuation of intraventricular hemorrhage was generally an effective and efficient way for hemorrhage evacuation,and contributed remarkably to the improvement of consciousness in patients with intraventricular hemorrhage.

Restoration of an injured lower dorsal ascending reticular activating system in a patient with intraventricular hemorrhage

The ascending reticular activating system（ARAS）plays a key role in the control of arousal and awareness for consciousness（Paus,2000;Zeman,2001;Van der Werf et al.,2002;Weiss et al.,2007;Siposan and Aliu,2014）.It is well known that the ARAS originates from the reticular formation（RF）of the brainstem,and connects to the cerebral cortex via intralaminar to the cerebral cortex （Paus, 2000; Zeman, 2001; Van der Werf et al., 2002; Yeo et al., 2013; Jang and Kwon, 2015）. The hypothalamus is involved in the regulation of sleep and awareness which is associated with the main timekeeper of consciousness （Lin, 2000; Lin et al., 2011）.

MECHANISM OF PATHOLOGICAL CHANGES OF INTRAVENTRICULAR HEMORRHAGE IN DOGS

Objective To probe the mechanism of pathological changes of intraventricular hemorrhage(IVH). Methods The evaluation of neurological status,serial CT scans and pathological examination were applied on the canine model of IVH. The ventricular volume and blood clot volume were measured based on the CT images. Results The normal adult canine ventricle tend to be slitlike. After injection, the ventricle was obviously dilated by the blood clot. The linear regression of ventricular volume against blood clot volume was significant in the first week. From then on, however, while the clots continued to shrink, the ventricular volume showed progressive enlargement. The clots were lysed completely within 3 to 4 weeks. The linear regression of the degree of ventricular dilatation against the first clot volume was also significant. In the pathological examination, we found the ependymal lining of ventricular system was destroyed and neurons in the subependymal areas developed acidophil necrosis, which was prominent around Sylvian aqueduct. Conclusion Hemorrhagic ventricular dilatation(HVD) is a prominent feature of IVH and also is a strong indicator for poor prognosis. Ischemic changes of periventricular neurons in some important structures may be the most direct cause for poor outcome of IVH. It may be induced by periventricular vascular structures compressed by HVD, increased intracranial pressure, cerebral vasospasm and others.

Interobserver reliability between pediatric radiologists and residents in ultrasound evaluation of intraventricular hemorrhage in premature infants

BACKGROUND Germinal matrix intraventricular hemorrhage(IVH)may contribute to significant morbidity and mortality in premature infants.Timely identification and grading of IVH affect decision-making and clinical outcomes.There is possibility of misinterpretation of the ultrasound appearances,and the interobserver variability has not been investigated between radiology resident and board-certified radiologist.AIM To assess interobserver reliability between senior radiology residents performing bedside cranial ultrasound during on-call hours and pediatric radiologists.METHODS From June 2018 to June 2020,neonatal cranial ultrasound examinations were performed in neonatal intensive care unit.Ultrasound findings were recorded by the residents performing the ultrasound and the pediatric attending radiologists.RESULTS In total,200 neonates were included in the study,with a mean gestational age of 30.9 wk.Interobserver agreement for higher grade(Grade III&IV)IVH was excellent.There was substantial agreement for lower grade(Grade I&II)IVH.CONCLUSION There is strong agreement between radiology residents and pediatric radiologists,which is higher for high grade IVHs.

Evacuation of Spontaneous Thalamic and Intraventricular Hemorrhage under the Operating Microscope Improves Mortality Compared with External Ventricular Drainage——Mini-Cranioctomy for Thalamic and Ventricular Hemorrhage

We performed direct hematoma evacuation of thalamic and intraventricular hemorrhage using mini-craniotomy in recent years. The present study evaluated the outcome and complications in 18 patients with spontaneous thalamic and intraventricular hemorrhage treated by mini-craniotomy hematoma evacuation with external ventricular drainage and 24 patients treated by only external ventricular drainage. Patients treated by mini-craniotomy were less likely to require days of ventricular drainage settlement, had a less suffering meningitis, had good hematoma evacuation rate and had a less mortality rate compared with those undergoing only external ventricular drainage. Frontal mini-craniotomy microscope operation is a simple and effective method for hematoma evacuation that causes fewer complications.

Selective verbal memory impairment due to left fornical crus injury in a patient with intraventricular hemorrhage

The fornix, a part of the Papez circuit, transfers information of episodic memory between the medial temporal lobe and the medial diencephalon （Aggleton and Brown, 1999）. The right medial temporal lobe is known to be specialized for visual memory and the left medial temporal lobe for verbal memory （Tucker et al., 1988; Aegleton and Brown, 1999）.

Advances in surgical treatment of intraventricular hemorrhage

Intraventricular hemorrhage(IVH)is a dangerous acute cerebrovascular disease.The 30-day mortality rate of patients with IVH is 5 times that of patients with cerebral hemorrhage.In recent years,more and more studies have shown that timely clearance of intraventricular hematoma is closely related to good prognosis.The advantages of surgical intervention in patient management are impressive.This article briefly reviews the positive advances in the surgical treatment of IVH such as external ventricular drainage(EVD)combined with intraventricular fibrinolysis(IVF)and continuous lumbar cistern drainage(LCD),as well as their safety and efficacy,especially the remarkable role of neuroendoscopy in the removal of intraventricular hematomas.

Prevalence, Risk Factors and Intra-Hospital Outcomes Relating to Peri-Intraventricular Hemorrhage in Premature Newborns of Gestational Age Less than 34 Weeks

Peri-intraventricular hemorrhage is one of the main causes of neurological impairment in premature newborns. To control their risk factors is necessary in view of the increasing survival of extreme preterm infants. Objective: To evaluate the prevalence of peri-intraventricular hemorrhage in premature newborns, identify the risk factors and observe the frequencies of intra-hospital outcomes of interests. Methods: This study was done in Brazil. This was an observational, analytical longitudinal and prospective study. The subjects included were newborns of gestational age less than 34 weeks who were admitted to two public hospitals between May and November 2015. To assess possible associated factors, obstetric, perinatal and neonatal data were analyzed (chorioamnionitis, antenatal corticosteroids, gestational age, newborn weight, Apgar score at 1 and 5 minutes, resuscitation in the delivery room, surfactant in the delivery room, newborn transferred from another hospital, respiratory distress syndrome: RDS, sepsis, umbilical vein catheterization, assisted ventilation, exogenous surfactant in the Neonatal ICU, use of sodium bicarbonate, inotropic agents, adrenaline, volume expanders and blood products). The hospital outcomes studied were assisted ventilation time, hospital stay and death. The data analysis was performed by chi-square test or Fisher’s test, with a significance level of 5%. Results: Out of 156 newborns, 46 (29.9%) presented peri-intraventricular hemorrhage and 28.2% of these had a severe form of the disease. There were significant associations (p < 0.05) with the following risk factors: gestational age, birth weight, low Apgar score, delivery room resuscitation, RDS, surfactant use, sepsis, packed red blood cell transfusion, mechanical ventilation and umbilical vein catheterization. The newborns with peri-intraventricular hemorrhage presented longer times on assisted ventilation, longer hospital stays and higher risk of death. Conclusion: The prevalence of peri-intraventricular hemorrhage was high in the population studied, especially the severe form. Perinatal and neonatal risk factors were associated with a higher risk of developing the disease and the outcomes studied were more evident in these newborns.

Influence of deferoxamine on hydrocephalus after intraventricular hemorrhage and expressions of Wnt1 and Wnt3a in rat

Objective To observe the effect of deferoxamine on chronic hydrocephalus after intraventricular hemorrhage (IVH) and the role of Wnt (Wnt1 and Wnt3a) . Methods A total of 130 Sprague Dawley male rats were randomly assigned into 4 groups: normal control group, sham IVH group,IVH group and deferoxamine-treated group.

High SIOOB levels in cerebrospinal fluid and peripheral blood of patients with acute basal ganglial hemorrhage are associated with poor outcome

S100B is involved in brain injury. This study aimed to determine plasma and cerebral spinal fluid （CSF） levels of S100B in patients with spontaneous intracerebral hemorrhage （ICH）, and to correlate S100B levels with Glasgow Coma Scale （GCS） scores, ICH volumes, presence of intraventricular hemorrhage （IVH）, and survival rate, and to correlate CSF S100B levels with plasma 100B levels as well as CSF interleukin-1 beta （IL-1β）levels. Ten patients with suspicion of subarachnoid hemorrhage and 38 patients with spontaneous basal ganglia hemorrhage were included in the study. Their plasma and CSF samples were collected. The concentrations of IL-1β in CSF and S100B in plasma and CSF were analyzed by enzyme-linked immunosorbent assay. Plasma or CSF S100B levels in the ICH group were significantly higher than those in the control group （178.7±74.2 versus 63.2±23.0 pg/ml; P〈0.001 or 158.1±70.9 versus 1.8±0.7 ng/ml; P〈0.001）. S100B levels were highly associated with GCS scores, ICH volumes, presence of IVH, and survival rate （all P〈0.05）. CSF S100B levels were highly associated with plasma S100B levels as well as CSF IL-113 levels （both P〈0.01） in patients with ICH. A receiver operating characteristic curve identified CSF and plasma S100B cutoff levels that predicted 1-week mortality of patients with a high sensitivity and specificity. The areas under curves （AUCs） of GCS scores and ICH volumes were larger than those of CSF and plasma $100B levels, but the differences were not statistically significant （P〉0.05）. High levels of S100B are present in the cerebrospinal fluid and peripheral blood of patients with ICH and may contribute to the inflammatory processes of ICH. The levels of CSF and plasma S100B after spontaneous onset of ICH seem to correlate with clinical outcome in these patients. Increases in peripheral S100B properly reflect brain injury, and plasma S100B level may serve as a useful clinical marker for evaluating the prognosis of ICH.

Minimally invasive puncture and drainage or patients with hypertensive spontaneous basal ganglia intracerebral hemorrhage: A prospective non-randomized comparative study of 198 cases

Background: The treatment of hypertensive spontaneous intracranial hemorrhage(ICH) is still controversial. The purpose of the present study was to investigate whether minimally invasive puncture and drainage(MIPD) could provide improved patient outcome compared with decompressive craniectomy(DC).Methods: Eligible, consecutive patients with ICH(≥30 ml, in basal ganglia, within 24 hours of ictus) were nonrandomly assigned to receive MIPD(group A) or to undergo DC(group B) hematoma evacuation. The primary outcome was death at 30 days after onset. Functional independence was assessed at 1 year using the Glasgow Outcome Scale(GOS, scores range from 1 to 5, score 1 indicating death, ≥4 indicating functional independence, with lower scores indicating greater disability). Results: A total of 198 patients met the per protocol analysis(84 cases in group A and 114 cases in group B), including 9 cases lost during follow-up(2 cases in group A and 7 cases in group B). For these 9 patients, their last observed data were used as their final results for intention-to-treat analysis. The mean age of all patients was 57.1 years(range of 31-95 years), and 114 patients were male. The initial Glasgow Coma Scale(GCS) score was 8.1±3.4, and the National Institutes of Health Stroke Scale(NIHSS) score was 20.8±5.3. The mean hematoma volume(HV) was 56.7±23.0 ml(range of 30-144 ml), and there was extended intraventricular hemorrhage(IVH) in 134 patients(67.7%). There were no significant intergroup differences in the above baseline data, except group A had a higher mean age(59.4±14.5years) than the mean age of group B(55.3±11.1 years, P=0.025). The total cumulative mortalities at 30 days and 1 year were 32.3% and 43.4%, respectively, and there were no significant differences between groups A and B(30 days: 27.4% vs. 36.0%, P=0.203; 1 year: 36.1% vs. 48.2%, P=0.112, respectively). However, the mortality for patients ≤60 years, NIHSS【15 or HV≤60 ml was significantly lower in group A than that in group B(all P【0.05). The total cumulative functional independence at 1 year was 26.8%, and the difference between group A(33/43, 39.3%) and group B(20/144, 17.5%) was significant(absolute difference 21.7%, odds ratio [OR] 0.329, 95% confidence interval [CI] 0.171 to 0.631, P=0.001). For patient with severe IVH, the 30 days and 1 year mortality rates were significant lower in group B than those in group A(P=0.025, P=0.036). However, the number of favorable outcomes had no significant difference between groups at 1 year post ictus. Multivariate logistic regression analysis showed that a favorable outcome after 1 year was associated with the difference in therapies(OR 0.280, 95% CI 0.104–0.752, P=0.012), age(OR 0.215, 95% CI 0.069–0.671, P=0.008), GCS(OR 1.187, 95% CI 1.010–1.395, P=0.037), HV(OR 0.943, 95% CI 0.906–0.982, P=0.005), IVH(OR 0.655, 95% CI 0.506–0.849, P=0.001) and PI(OR 0.211, 95% CI 0.071–0.624, P=0.001). Conclusions: Our results suggest that for patients with hypertensive spontaneous ICH(HV≥30 ml in basal ganglia), MIPD may be a more effective treatment than DC, as assessed by a higher rate of functional independence at 1 year after onset as well as reduced mortality in patients ≤60 years of age, NIHSS【15 or HV≤60 ml. For patients with HV 】60 ml, deep coma and severe IVH, the outcomes of the two therapies were similar.

Long-term outcomes of very low birth weight infants with intraventricular hemorrhage:a nationwide population study from 2011 to 2019

Background Advancements in neonatal care have increased preterm infant survival but paradoxically raised intraventricular hemorrhage(IVH)rates.This study explores IVH prevalence and long-term outcomes of very low birth weight(VLBW)infants in Korea over a decade.Methods Using Korean National Health Insurance data(NHIS,2010-2019),we identified 3372 VLBW infants with IVH among 4,129,808 live births.Health-related claims data,encompassing diagnostic codes,diagnostic test costs,and administered procedures were sourced from the NHIS database.The results of the developmental assessments are categorized into four groups based on standard deviation(SD)scores.Neonatal characteristics and complications were compared among the groups.Logistic regression models were employed to identify significant changes in the incidence of complications and to calculate odds ratios with corresponding 95%confidence intervals for each risk factor associated with mortality and morbidity in IVH.Long-term growth and development were compared between the two groups(years 2010-2013 and 2014-2017).Results IVH prevalence was 12%in VLBW and 16%in extremely low birth weight(ELBW)infants.Over the past decade,IVH rates increased significantly in ELBW infants(P=0.0113),while mortality decreased(P=0.0225).Major improvements in certain neurodevelopmental outcomes and reductions in early morbidities have been observed among VLBW infants with IVH.Ten percent of the population received surgical treatments such as external ventricular drainage(EVD)or a ventriculoperitoneal(VP)shunt,with the choice of treatment methods remaining consistent over time.The IVH with surgical intervention group exhibited higher incidences of delayed development,cerebral palsy,seizure disorder,and growth failure(height,weight,and head circumference)up to 72 months of age(P<0.0001).Surgical treatments were also significantly associated with abnormal developmental screening test results.Conclusions The neurodevelopmental outcomes of infants with IVH,especially those subjected to surgical treatments,continue to be a matter of concern.It is imperative to prioritize specialized care for patients receiving surgical treatments and closely monitor their growth and development after discharge to improve developmental prognosis.

脑室-腰大池序贯引流治疗重度脑室出血后继发引流依赖性脑积水的原因分析

目的探究对重度脑室出血患者行脑室-腰大池序贯引流后发生脑积水的影响因素。方法选择2017年1月至2022年1月泉州市第一医院神经外科收治的重度脑室出血患者99例。根据是否继发脑积水分为实验组(n=33)和对照组(n=66),比较分析两组患者的临床数据。结果实验组患者Graeb评分更高,脑脊液引流速度≤8-10 ml/h的比例更高,引流时程≤7 d的比例更高,上述差异均具有统计学意义(P<0.05),实验组患者治疗有效率为72.73%,显著低于对照组(88.76%),差异有统计学意义(P<0.05)。结论脑室-腰大池序贯引流治疗重度脑室出血是安全有效的。高Graeb评分、脑脊液引流速度慢(≤8-10 ml/h)、引流时程短(≤7 d)等均是脑室出血引流术后继发引流依赖性脑积水的独立危险因素,针对性地减少上述危险因素,可减少脑积水的发生率,改善预后。

神经内镜微创手术降低自发性脑室出血后慢性脑积水的临床研究

目的 探讨神经内镜微创手术降低自发性脑室出血(IVH)后慢性脑积水的临床研究。方法 回顾性分析2020年9月-2022年9月厦门大学附属中山医院收治的157例自发性IVH患者,分为引流组、显微镜组、神经内镜组,比较三组患者的术前格拉斯哥昏迷指数(GCS)评分、术前改良格拉斯哥昏迷指数(mGS)评分、Evan's指数、24 h血肿清除率、手术时间、住院时间、并发症发生情况、死亡率、出院时GCS评分、mRS预后评分、出院时Evan's指数以及手术后6个月脑积水发生率。结果 与引流组和显微镜组相比,神经内镜组的血肿清除率、出院时GCS评分显著升高(P<0.05),手术时间、住院时间、并发症发生率、死亡率、出院时Evan's指数、出院时mRS评分和手术后6个月脑积水发生率明显降低(P<0.05)。结论 自发性IVH采用神经内镜手术治疗能快速清除大部分血肿,显著减少慢性脑积水发生率,有效防止IVH后慢性脑积水的发生。

颅脑超声对宫内窘迫新生儿脑损伤的早期诊断价值

目的探讨颅脑超声对宫内窘迫新生儿脑损伤的诊断价值。方法对146例宫内窘迫新生儿行颅脑超声及常规MRI检查,并将超声检查结果与MRI结果进行对比分析。根据脑损伤情况分为脑损伤组(n=46)和无脑损伤组(n=100),分析比较2组新生儿大脑中动脉和前动脉血流动力学指标[收缩期血流速度(PSV)、舒张末期血流速度(EDV)及阻力指数(RI)],采用受试者工作特征(ROC)曲线分析其对脑损伤的诊断价值。结果146例宫内窘迫新生儿中46例存在影像学异常征象,阳性检出率31.74%(46/146),其中MRI的检出率为91.30%(42/46),明显高于颅脑超声的65.22%(30/46,χ^(2)=9.200,P=0.002)。缺氧缺血性脑病(12.33%比5.48%,χ^(2)=4.222,P=0.040)、硬膜或蛛网膜下腔出血(2.74%比0,χ^(2)=4.056,P=0.044)的MRI检出率明显高于颅脑超声(P<0.05),脑室周围-脑室内出血的颅脑超声检出率明显高于MRI(11.64%比4.79%,χ^(2)=4.540,P=0.033)。脑损伤组新生儿大脑中动脉和前动脉PSV、EDV小于无脑损伤组,RI大于无脑损伤组(P<0.05)。ROC曲线显示,大脑中动脉和前动脉PSV、EDV和RI诊断脑损伤的曲线下面积分别为0.710、0.786、0.625和0.740、0.819、0.613。结论颅脑超声可早期发现宫内窘迫新生儿脑组织结构改变及血流动力学变化,在脑室周围-脑室内出血方面的检出率优于MRI,但脑损伤诊断效果不如MRI,临床可根据患儿情况选择合适检查方案。

倍他米松磷酸钠注射液治疗早产有效性和安全性研究进展

倍他米松是地塞米松的同分异构体,具有抗炎、抗过敏、抗内毒素和免疫抑制等功能。倍他米松磷酸钠(BSP)注射液是倍他米松的磷酸盐制剂,作为一种糖皮质激素(ACS)类药物,其临床应用较广。BSP治疗早产已有充分的证据并被纳入各国指南,然而这些证据主要集中在高收入国家,中低收入国家相关证据则较少。我国关于BSP在产科应用疗效和安全性临床研究方面存在不足。关于倍他米松和地塞米松疗效和安全性直接比较的临床研究较少,BSP治疗早产后儿童期和成年期随访研究尚不足。因此,需进一步开展相关研究,为早产临床科学合理用药提供决策依据。