新生儿脑梗死76例临床特点、影像学变化及预后分析  

Analysis of clinical manifestations,cranial imaging changes and prognosis of 76 cases with neonatal cerebral infarction

作　　者：杨子馨 王亚娟 刘蕾 丁翊君 Yang Zixin;Wang Yajuan;Liu Lei;Ding Yijun(Neonatal Center,Beijing Children′s Hospital,Capital Medical University,National Children′s Center of Health,Beijing 100045,China)

机构地区：[1]首都医科大学附属北京儿童医院新生儿中心,国家儿童医学中心,100045

出　　处：《中华实用儿科临床杂志》2019年第23期1788-1791,共4页Chinese Journal of Applied Clinical Pediatrics

摘　　要：目的对76例新生儿脑梗死患儿的流行病学特点、临床表现、影像学特点进行总结,以期为该病的诊断、治疗及预后提供有力的指导.方法选取2007年1月至2017年12月首都医科大学附属北京儿童医院新生儿中心收治的新生儿脑梗死患儿,根据是否留有神经系统后遗症将随访患儿分为预后良好组和预后不良组进行回顾性分析,对部分患儿进行系统随访、定期影像学复查、智体力发育评测.结果76例患儿中惊厥起病占比最高(73.7%,56/76例),其中单侧肢体抽动具有特征性,占39.2%(22/56例).临床查体无明显阳性体征占13.2%(10/76例),大脑中动脉受累占80.3%(61/76例),29.2%(19/65例)的患儿脑电图可无异常放电.41例接受随访患儿中,12例(29.3%)留有神经系统后遗症,15例(36.6%)接受小剂量低分子肝素肌内注射抗凝治疗.29例患儿定期复查头颅影像,预后良好组头颅磁共振成像(MRI)T2序列脑梗死原始受损面积占比中位数为10.3%,弥散加权像受损占比中位数为2.0%,复查头颅MRI T2序列受损面积占比中位数为1.0%.颅脑病变受损占比差值中位数为8.4%.预后不良组各组比值分别为14.9%、4.8%、0.5%、14.4%.结论新生儿惊厥是新生儿脑梗死最常见表现,单侧肢体阵挛具有特征性.胎盘功能不全可能是造成新生儿脑梗死的根本原因之一.梗死累及面积越大,复查颅内病变变化面积越大,患儿预后较差,弥散加权像受累面积不能提示预后.早期进行抗凝治疗不能改善新生儿脑梗死预后.Objective To analyze the epidemiological characteristics,clinical manifestations and imaging charac-teristics of 76 cases with neonatal cerebral infarction,in order to provide evidence for the diagnosis,treatment and prognosis for neonal cerebral infarction.Method Newborns with cerebral infarction admitted into the Neonatal Center,Beijing Children′s Hospital,Capital Medical University from January 2007 to December 2017 were enrolled.According to neurological sequelae,the participants were divided into good prognosis group and poor prognosis group for retrospective analysis,and their cranial magnetic resonance imaging(MRI)changes and mental development were followed up.Results The incidence of convulsion was the highest in 76 cases(73.7%,56/76 cases),among which unilateral limb twitching was characteristic in 39.2%(22/56 cases).Clinical physical examination showed no significant positive signs in 13.2%(10/76 cases)of the patients,but middle cerebral artery involvement accounted for 80.3%(61/76 cases),and there was no abnormal discharge of electroencephalogram in 29.2%(19/65 cases)of the patients.Among 41 children(29.3%)received follow-up,12 cases had neurological sequelae,and 15 cases(36.6%)received anticoa-gulant therapy.The median area of original damage of T2 sequence cerebral infarction was 10.3%,the median area of diffusion weighted image damage was 2.0%,and the median area of damage of T2 sequence was 1.0%.The median ratio of craniocerebral lesion damage was 8.4%.The ratios of poor prognosis were 14.9%,4.8%,0.5%and 14.4%,respectively.Conclusions Neonatal convulsion is the most common manifestation of neonatal cerebral infarction.Unilateral limb clonus is characteristic.The larger the infarct involvement area and the larger the intracranial lesion change area through reexamination,the poorer prognosis of the children.Early anticoagulant therapy could not improve the prognosis of neonatal cerebral infarction.

关 键 词：脑梗死 婴儿 新生 磁共振成像 预后 

分 类 号：R74[医药卫生—神经病学与精神病学]