晚发性维生素K缺乏性颅内出血92例临床分析  

Clinical analysis of 92 cases of intracranial hemorrhage due to late Vitamin K deficiency

作　　者：康杰[1] 杨宝昌[1] 赵津生[1] 

机构地区：[1]天津市儿童医院PICU,天津300074

出　　处：《中国现代医学杂志》2010年第18期2834-2836,2839,共4页China Journal of Modern Medicine

摘　　要：目的探讨晚发性维生素K缺乏性颅内出血的病因、治疗方法及预防措施。方法对该院收治的92例晚发性维生素K缺乏性颅内出血患儿进行回顾性分析。其中纯母乳喂养83例、腹泻病史30例、肝功能异常39例、抗生素使用史28例为主要发病原因。分别予静脉注射维生素K1及止惊、降颅压、输血对症支持治疗,其中有13例患儿行硬膜下穿刺放血治疗,有7例患儿转外科行硬膜下血肿钻孔引流治疗。结果治愈76例,死亡2例,放弃治疗14例。随访了12例存活病儿,有10例存有不同程度的后遗症。结论对于本病要早诊断、早治疗,而做好预防工作是提高治愈率、减少病死率和致残率的关键。建议产院予新生儿预防性肌注维生素K1,对于3个月以内的单纯母乳喂养儿,在合并长期腹泻、黄疸延迟或患有肝胆疾病、应用抗生素、存在吸收障碍时均应补充维生素K。【Objective】 To study the etiological factors,method of treatment and preventive measure of intracranial hemorrhage due to late Vitamin K deficiency.【Methods】 A retrospective study was carried out to analyze the clinical features and outcome of intracranial hemorrhage due to late Vitamin K deficiency in 92 infants admitted to our hospital.The risk factors for intracranial hemorrhage associated with Vitamin K deficiency included exclusively breast-fed infant（83/92）,diarrhea（30/92）,liver dysfunction（39/92） and history of antibiotics（28/92）.All patients were treated by giving Vitamin K,repelling convulsion,lowering encephalic pressure,transfusing fresh blood and support treatment.Among them,13 cases were performed phlebotomy through the dura mater,7 cases were transferred to surgical department for clearance of the subdural hematoma.【Results】Seventy-six cases（76/92） were healed,two（2/92） died,fourteen（14/92） gave up treatment.Twelve survival infants were followed up,in which 10 had sequelae in varying degrees.【Conclusions】 The early diagnosis and proper treatment of late Vitamin K deficiency bleeding,especially Vitamin K prophylaxis are of much clinical significance in raising cure rate and reducing mortality rate and disability rate.We suggest that neonates receive Vitamin K1 intramuscularly after delivery in every maternity hospital.The infants with exclusively breast-fed younger than three months should receive vitamin K when they are sick by chronic diarrhea,durative jaundice,liver and gall bladder diseases,application of antibiotics and malabsorption.

关 键 词：晚发性维生素K缺乏出血 颅内出血 婴儿 

分 类 号：R723.2[医药卫生—儿科]