婴儿迟发型维生素K缺乏致颅内出血35例临床特点分析及预防  

ANALYSIS AND PREVENTION OF CLINICAL FEATURES OF 35 INFANTS OF INTRACRANIAL HEMORRHAGE CAUSED BY DELAYED VITAMIN K DEFICIENCY

作　　者：郭文英[1] 

机构地区：[1]河南省濮阳市人民医院儿内科,濮阳457000

出　　处：《现代预防医学》2011年第23期4868-4869,4871,共3页Modern Preventive Medicine

摘　　要：[目的]探讨婴儿迟发型维生素K缺乏致颅内出血35例临床特点分析及防治方法。[方法]所有患儿确诊后立即给予维生素K1 5～10 mg静脉,连用3～5 d,重者可输血10～15 ml/kg/次,1次/d,共用l～3 d。颅内压明显增高或反复惊厥者,联合应用甘露醇和地塞米松,并给予镇静剂和其他止血剂以及抗炎、营养支持等疗法。必要时,部分患儿根据症状给予侧脑室穿刺或前囟穿刺放液。急性期后使用神经节苷脂促进神经生长和改善脑血流的药物复方丹参液,对部分有侧脑室扩大者,使用碳酸酐酶抑制剂醋氮酰胺,以减少患儿神经系统后遗症的发生。对所有患儿的临床资料、防治及预后等资料进行统计分析。[结果]本组患儿35例,放弃1例、死亡1例,转院2例,出院1年后随防24例,遗留神经系统后遗症11例。临床表现方面,74.29%患儿面色苍白,65.71%患儿前囟饱满或隆起,37.14%患儿拥抱反射减弱或消失,62.86%患儿注射部位出血,31.42%患儿惊厥抽搐,8.57%患儿意识障碍伴瞳孔不等大,20.00%患儿呕吐,4例患儿血红蛋白32～59 g/L,8例60～90 g/L,23例90～120 g/L。35例患儿CT表现为蛛网膜下腔出血16例,硬膜下血肿9例,脑实质出血7例,脑室内出血3例,混合性出血l0例。并发脑水肿14例,脑疝9例,大面积脑梗死4例。[结论]该病致残率较高,若不积极正确治疗,死亡率高,应早期诊断,合理治疗以降低其死亡率及致残率;对具有患该病危险因素的婴儿,应早期使用维生素K预防。[Objective]To investigate the clinical features of 35 infants of intracranial hemorrhage caused by delayed vitamin K deficiency.[Methods]All patients were given intravenous vitamin K1 5 to 10mg immediately after being diagnosed,lasted for 3 to 5 days.The serious patients might be given with blood transfusion l0 to 15ml/kg/time,once a day,and for 1 to 3 days.The patients with significantly increased intracranial pressure or repeated seizures were treated with the combination of mannitol and dexamethasone,and given sedatives and other hemostatic agents,and anti-inflammatory,nutritional support therapy.When necessary,some patients were given repeated lumbar puncture or symptomatic lateral or anterior fontanelle puncture paracentesis.After the acute phase,they were taken brain cell metabolism activator with citicoline to improve cerebral blood flow of the drug Danshen solution.For those who had lateral expansion,took use of carbonic anhydrase inhibitor acetazolamide to reduce neurological sequelae in children occurred.The clinical data,prevention and prognosis data for all children were taken for statistical analysis.[Results]Children in this group of 35 cases,1 patient gave up,1 patient died,2 cases transferred,discharged a year later with the defense were in 24 cases,left the nervous system sequelae were in 11 cases.In the clinical performance,74.29% of the children were pale in the face,65.71% of the children were with full or anterior fontanelle bulge,37.14% of the children were reduced or lost of embrace reflex,62.86% of the children were with injection site hemorrhage,31.42% of the children were with seizures and convulsions,8.57% of the children had disturbance of consciousness with pupils ranging from large,20.00% of the children were with vomiting,four patients were given blood protein 32 to 59g/L,8 cases with 60 to 90g/L,23 cases with 90 to 120g/L.In the 35 cases of children with CT showed subarachnoid hemorrhage were in 16 cases,nine cases were with subdural hematoma,intraventricular hemorrhage quality wer

关 键 词：婴儿 迟发型维生素K缺乏 颅内出血 

分 类 号：R743.34[医药卫生—神经病学与精神病学]