连续腰穿防治早产儿重度脑室内出血后脑积水的多中心调查报告  

Multicenter investigation report on the effect of serial lumber puncture on severe post-hemorrhagic hydrocephalus in premature infants

作　　者：陈惠金[1] 魏克伦[2] 周丛乐[3] 姚裕家[4] 杨于嘉[5] 范秀芳[6] 高喜容[7] 江莲[8] 刘晓红[9] 钱继红[10] 王莉[11] 吴本清 吴高强 张青梅[14] 张小兰[15] 周晓玉[16] 

机构地区：[1]上海交通大学医学院附属新华医院、上海市儿科医学研究所,上海200092 [2]中国医科大学附属盛京医院儿科,沈阳110004 [3]北京大学附属第一医院儿科,北京100034 [4]四川大学附属华西第二医院儿科,成都610041 [5]中南大学附属湘雅医院儿科,长沙410011 [6]山东省济南市妇幼保健院新生儿科,济南250012 [7]湖南省儿童医院新生儿科,长沙410007 [8]河北医科大学第四医院儿科,石家庄050001 [9]深圳市儿童医院新生儿科,深圳518026 [10]上海交通大学医学院附属新华医院儿科,上海200092 [11]新疆医科大学第一附属医院儿科,乌鲁木齐830054 [12]暨南大学第二附属医院深圳市人民医院新生儿科,深圳518020 [13]新疆乌鲁木齐市妇幼保健院儿科,乌鲁木齐830000 [14]沈阳市妇婴医院新生儿科,沈阳110014 [15]深圳市妇幼保健院新生儿科,深圳518028 [16]南京大学附属南京儿童医院新生儿科,南京210008

出　　处：《中国实用儿科杂志》2009年第8期621-626,630,共7页Chinese Journal of Practical Pediatrics

基　　金：中华医学会儿科分会新生儿学组立项课题

摘　　要：目的报告其中6家大型医院通过连续腰穿(LP)防治早产儿重度脑室内出血(IVH)后脑积水的调查结果。方法2005年1月至2006年8月,对各参加单位所有Ⅲ级及以上IVH、胎龄<37周的早产儿在B超监护下进行连续LP,每次LP后脑脊液送检常规、生化。经头颅B超诊断为重度IVH的早产儿共99例,其中6家医院随机对30例重度IVH早产儿进行连续LP治疗,作为连续LP组;其余10家单位(包括上述6家单位)所有未进行连续LP治疗的69例重度IVH早产儿作为对照组。收集并分析2组LP期间脑室系统的B超测量和脑脊液检查数据。结果连续LP组30例早产儿开始LP治疗日龄为(14.5±6.8)d;疗程(7.4±7.6)d;LP次数(4.2±3.1)次;LP间隔时间(3.8±2.2)d;每次放液量(6.6±3.2)mL;LP治疗后起效天数为(9.9±8.6)d。左右侧脑室的纵径分别由LP前的(8.2±3.5)mm和(7.6±3.8)mm下降为连续LP后的(5.8±2.4)mm和(5.2±2.8)mm(t=4.872,P=0.000;t=4.416,P=0.000)。LP治疗后的脑脊液红细胞计数及蛋白定量均呈明显降低(t=4.061,P<0.000;t=2.764,P<0.009)。11例脑室转为正常;14例脑室轻度增大但维持稳定;2例脑室仍呈进行性增大;另3例缺乏脑室测量数据。连续LP治疗有效率为83.3%(25/30例),脑积水发生率为6.7%(2/30)。对照组4例脑室转为正常;29例脑室轻度增大但维持稳定;18例脑室仍呈进行性增大;另有18例缺乏脑室测量数据。对照组良好预后率为47.8%(33/69),脑积水发生率为26.1%(18/69),两组在脑室形态转归之间的差异有统计学意义(χ2=10.954,P<0.004)。结论连续LP治疗可降低出血后脑积水的发生率,显著改善重度IVH患儿的近期不良预后,不失为目前防治早产儿出血后脑积水的首选内科治疗措施,尤其适宜于暂无小儿脑外科手术条件的医院。Objective Sponsored by the Subspecialty Group of Neonatology of Pediatric Society, China Medical Association, more than ten large-scale hospitals join the 20-month muhieenter investigation for brain injuries in premature infants in China. The present study presents the investigaton result on the effect of serial lumber puncture （LP） on severe post-hemorrhagic hydrocephalus in premature infants in 6 big hospitals that all belong to the third class and A level licensed by China. Methods Serial LP therapy was undertaken in 30 premature infants with severe intraventricular hemorrhage （IVH） in 6 hospitals as serial LP group, 69 premature infants with severe IVH that did not receive serial LP therapy in 10 hospitals as control group during Jan. 2005 to Aug. 2006. The effect of serial LP therapy was monitored by cranial uhasound. The data of lateral ventricular size measured by cranial uhasound were collected during therapy. Results No significant differences in the gestational age, birth weight, gender, Apgar scores and delivery mode were found between serial LP group and control group. The serial LP therapy was initiated at （14.5 ± 6.8） days of life and maintained for （7.4 ± 7.6） （median： 5） days. LP was repeated （4.2 ± 3.1） times with the interval of （3.8±2.2） days. The CSF volume removed was （6.6 ± 3.2） mL. The occurrence of LP effect was （9.9 ± 8.6） （ 1 - 30） days since LP was initiated. The reduction or stabilization of ventricular size was observed in all premature infants except for five cases. The vertical diameter of left and right lateral ventricles reduced from （8.2 ± 3.5）mm and （7.6 ± 3.8）mm before therapy to （5.8±2.4）mm and （5.2±2.8）mm after therapy （t = 4.872, P = 0.000; t = 4.416, P = 0.000）. There was an obvious decrease in red cells counts and protein levels of CSF after therapy （t = 4.061,P 〈 0.000;t = 2.764,P 〈 0.009）. The effective rate of serial LP therapy was 83.3% （25130） consisting of the normal ventricular size

关 键 词：早产儿 脑室内出血 出血后脑积水 连续腰穿治疗 

分 类 号：R72[医药卫生—儿科]