经腰穿释放脑脊液治疗新生儿重度脑室合并蛛网膜下腔出血  

Release Cerebral Spinal Fluid by Serial Lumbar Puncture in Treatment of Severe Intraventricular Hemorrhage and Subarachnoid Hemorrhage

作　　者：符明凤[1] 吴明赴[1] 欧青林[1] 王伏东[1] 

机构地区：[1]东南大学医学院附属扬州医院,江苏扬州225001

出　　处：《实用医技杂志》2005年第10B期2872-2873,共2页Journal of Practical Medical Techniques

摘　　要：目的:探讨经腰穿释放脑脊液治疗新生儿重度脑室合并蛛网膜下腔出血的疗效。方法:对5例上述病例在止惊、止血、降低颅内压及维持循环稳定等对症治疗的基础上,在生命体征稳定、临床无颅内高压体征时,尽早进行腰穿释放脑脊液治疗。第一次腰穿生后4 d^7 d,(1~2)d一次,每次释放脑脊液量2 m l^7 m l,平均3.8 m l,共4次~10次不等,平均7.4次。结果:5例中CT正常者3例,1例脑室轻度扩张,但保持稳定,1例有正常颅压性脑积水。随访0.5 a^3 a,1例正常颅压性脑积水者有智能障碍及运动发育落后,其余发育正常。结论:经腰穿释放脑脊液治疗新生儿重度脑室合并蛛网膜下腔出血疗效好,且安全可靠,实用性强,易于推广。Objective To investigate the effect of treatment of releasing cerebral fluid byserial lumbar puncture on newborns with severe intraventricular hemorrhage（IVH）and subarachnoid hemorrhage（SAH）. Methods 5 cases with severe IVH and SAH were given the treatment of releasing cerebral fluid by serial lumbar puncture ass possible as early on the base of controlling convulsion and bleeding and decompressing cerebral pressure and maintaining the stability of circulation. The first spinal taps were started at postnatal age of 4-7 days. Removal of 2 ml-7 ml cerebrospinal fluid was conducted each time and an average of cerebrospinal fluid was 3.8 ml. An average of 7.4 taps with interval of 1-2 days was carried out. Results Hydrocephalus was successfully prevented in 4 of the 5 cases. The ventricular size was normal in 3 infants and enlarged slightly and steadily in one o The infant with hydrocephalus was suffered cerebral paralysis and the others was normal when these infants were followed up at （0. 5-3） years. Conclusion The results suggest that serial LP is effective and safety in arresting the development of posthemorrhagic hydrocephalus and should be routinely undertaken for the newborns with severe IVH and SAH.

关 键 词：新生儿 脑室内出血 蛛网膜下腔出血 连续腰穿 出血后脑积水 

分 类 号：R743[医药卫生—神经病学与精神病学]