新生儿缺氧／缺血性颅内出血的超声显像与临床研究  

Ultrasonography study of infant intracranial hemorrhage caused by hypoxic ischemic encephalopathy

作　　者：刘露阳[1] 洪蓓蕾 吴长君[1] 张锋[1] 孙萍 

机构地区：[1]哈尔滨医科大学附属第一医院超声科,150001 [2]哈尔滨市南岗区妇产医院超声科,150080 [3]黑龙江省康复医院超声科

出　　处：《中国急救医学》2009年第7期649-651,共3页Chinese Journal of Critical Care Medicine

摘　　要：目的 探讨超声显像在新生儿缺氧／缺血性脑病（HIE）引起的颅内出血中的应用和发展演变过程与临床预后的关系，为临床诊断和治疗提供影像学判别标准。方法选择经临床确诊不同程度的HIE所致颅内出血的足月儿42例和早产儿23例，以新生儿前囟门为声窗进行冠、矢状面超声检查。初次检查为生后2h-7d，如有阳性诊断则住院期间每3～5d进行复查，出院后1—3个月进行复查。结果早期颅内出血足月儿以脉络丛出血为主，早产儿以室管膜下出血为主。晚期颅内出血足月儿及早产儿均以梗阻性脑积水为主。足月儿早期Ⅰ、Ⅱ度颅内出血与Ⅲ、Ⅳ度颅内出血对后遗症的产生比较差异有统计学意义（P〈0．01）；早产儿早期Ⅰ、Ⅱ度颅内出血与Ⅲ、Ⅳ度颅内出血对后遗症产生比较差异无统计学意义（P〉0．05）。患有颅内出血的早产儿比足月儿更易引起后遗症。结论①超声显像能较好地反映新生儿缺氧／缺血性脑病颅内出血的部位及类型，可动态观察颅内出血的变化过程。②对HIE足月儿早期Ⅲ、Ⅳ度颅内出血及早产儿早期颅内出血要引起重视；如患儿声像图中出现颅内出血后产生梗阻性脑积水征象则预示预后不良。Objective To study the application of ultrasonic imaging to intracranial hemorrhage （ICH） caused by hypoxic ischemic encephalopathy （ HIE） and the relationship between the development process of brain injury and the prognosis in HIE in order to provide more scientific imageologic standards for clinical diagnosis and treatment. Methods The cranial ultrasonic imaging of 42 term infants with HIE and 23 premature infants with asphyxia were recorded. The ultrasonic inspection of coronal and vertical plane was carried on through bregmatic fontanel of neonatus. The first image was checked from the first 2 hours to 7days after birth, those infants with positive ultrasonic diagnosis were rechecked every 3 to 5 days in the duration of hospital stay and 1 to 3 months later after the discharge. Results Term infants with early intraeranial hemorrhage mainly had choroid plexus hemorrhage （ CPH ）, while premature infants mainly had subependymal hemorrhage （SEHI. Term and premature infants who has intracranial hemorrhage at the advanced stage mainly has obstructive hydrocephalus. There was obviously statistical difference in sequela between early Ⅰ Ⅱ degree ICH and Ⅲ, Ⅳ degree ICH of term infant（P 〈0.01 ） ; there was no obviously statistical difference in sequela between premature infant early Ⅰ , Ⅱ degree ICH and Ⅲ, Ⅳ degree ICH （ P 〉 0.05 ）. Conclusion ①Cranial ultrasonic imaging could reflect the site and type of ICH in HIE, and could observe the development process of ICH.②term infants with HIE who have early Ⅲ and Ⅳ intracranial hemorrhage, preterm infants who have intraeranial hemorrhage should be paid more attention. Obstructive hydrocephalus after ICH in HIE patients indicates unfavorable prognosis.

关 键 词：超声显像 新生儿 缺氧/缺血性脑病 颅内出血 

分 类 号：R722.151[医药卫生—儿科]