早期脑室外引流术治疗早产儿或低出生体重儿生发基质-脑室内出血  

Early external ventricular drainage for the treatment of premature/low-birth weight neonates with germinal matrix intraventricular hemorrhage

作　　者：钱虎飞[1] 魏嘉[1] 刘瑜[1] 龚小慧[2] 刘剑钢[1] 裘刚[2] 陈若平[1] 

机构地区：[1]上海交通大学附属儿童医院神经外科,上海200062 [2]上海交通大学附属儿童医院新生儿科,上海200062

出　　处：《中华神经外科杂志》2016年第9期886-889,共4页Chinese Journal of Neurosurgery

摘　　要：目的观察早期持续脑室外引流术（EVD）治疗早产儿和（或）低出生体重儿生发基质-脑室内出血（GM-IVH）的临床疗效。方法回顾性纳入2013年1月至2014年2月上海交通大学附属儿童医院神经外科收治的随访期超过24个月的Ⅲ级以上GM-IVH患儿14例。所有患儿明确诊断后均急诊行侧脑室外引流术持续引流脑脊液，采用闭式脑脊液引流系统预防继发性颅内感染。结果14例患儿脑室外引流时间平均为（11．9±1．7）d，脑脊液引流量为（33．0±12．9）ml／d，脑室内压均控制在50mmH2O以下。所有病例经EVD后，脑室内出血均消失。14例患儿拔除脑室外引流后2个月复查，8例脑室系统仍进行性扩张，遂行脑室一腹腔分流术（VPS）；VPS后2个月脑室系统有所缩小。6例EVD后24个月随访，脑室系统较术前有所缩小，未施行VPS术。结论早期EVD治疗早产和（或）低体重GM—IVH患儿可能有助于防止出血后脑积水的发生，减少行VPS术的比例。Objective To observe the clinical efficacy of early external ventricular drainage （EVD） for the treatment of premature and/or low-birth weight neonates with germinal matrix intraventricular hemorrhage （GM-IVH）. Methods A total of 14 children with GM-IVH grade III followed up for more than 24 months and admitted to the Department of Neurosurgery, Shanghai Children＇s Hospital, Shanghai Jiao Tong University from January 2013 to February 2014 were enrolled retrospectively. All children were treated with emergent lateral ventricle external drainage for continuous drainage of cerebrospinal fluid after the definite diagnosis. The closed cerebrospinal fluid （CSF） drainage system was applied to prevent secondary intracranial infection. Results The mean EVD time of 14 children was 11.9 ± 1.7 d, the volume of CSF drainage was 33.0 ± 12.9 ml/d, and the intraventricular pressure （IVP） was controlled under 50 mmH20. The intraventricular hemorrhage disappeared in all cases after EVD. The examination at 2 month after the removal of external ventricular drainage in 14 children, the ventricular system continued to expand in 8 cases. Then the ventriculo-peritoneal shunt （VPS） was performed. At 2 months after VPS, the ventricular system was reduced. After EVD, 6 cases were followed up for 24 month, and the ventricular system was reduced, and none of them underwent VPS. Conclusion The early treatment of premature/low-birth weight neonates with GM-IVH may help to prevent the occurrence of hydrocephalus after bleeding and reduce the proportion of conducting VPS.

关 键 词：婴儿 早产 婴儿 出生时低体重 颅内出血 脑室 脑积水 生发基质 脑室外引流术 脑室-腹腔分流术 

分 类 号：R722.6[医药卫生—儿科]