213例儿童自发性颅内出血的临床分析  

Etiology and clinical features of children with spontaneous intracranial hemorrhage: a clinical analysis of 213 cases

作　　者：赵雪灵 梁平[1] 翟瑄[1] 李禄生[1] 周渝冬[1] 于增鹏[1] 周建军[1] 纪文元[1] 邹彬[1] Zhao Xueling;Liang Ping;Zhai Xuan;Li Lus he ng;Zhou Yudong;Yu Zengpeng;Zhou Jianjun;Ji Wenyuan;Zou Bin(Department of Neurosurgery,Children's Hospital of Chongqing Medical Universily,Ministry of Education Key Laboratory of Child Development and Disorder,China International Science and Technology Cooperation Base of Child Development and Critical Disorders,Chongqing Key Lab oratory of Pediatrics)

机构地区：[1]重庆医科大学附属儿童医院神经外科,儿童发育疾病研究教育部重点实验室,儿童发育重大疾病国家国际科技合作基地,儿科学重庆市重点实验室,重庆400014

出　　处：《重庆医科大学学报》2020年第1期134-138,共5页Journal of Chongqing Medical University

基　　金：国家临床重点专科建设资助项目(编号:国卫办医函[2013]544)。

摘　　要：目的:探讨儿童自发性颅内出血的病因及临床特点。方法:收集重庆医科大学附属儿童医院2012年1月至2017年12月收治的自发性颅内出血患儿213例,对其年龄、病因及计算机断层扫描(computer tomography,CT)表现等临床资料进行分析。结果:本组儿童自发性颅内出血好发于婴幼儿(21.1%)及学龄期(41.3%),血管畸形(44.1%)、肺吸虫脑病出血型(23.5%)及凝血功能障碍(22.1%)为主要病因,婴幼儿期多因凝血功能障碍出血,学龄前期以肺吸虫脑病出血为主,学龄期及青春期患儿以血管畸形为主;凝血功能障碍所致的出血多为多个解剖部位同时出血,血管畸形破裂出血多为单个解剖部位出血,常位于脑实质及脑室内,肺吸虫脑病所致的出血均位于额顶枕叶皮层内浅表部位,随血肿的稳定及吸收,病灶外周可见环形高密度,周围水肿明显。结论:儿童自发性颅内出血在年龄、病因上有特征性分布,不同病因所致出血有特征影像学表现,结合年龄及影像学表现可初步判断出血原因,在处理出血的同时,积极对因治疗减少再出血风险。Objective:To investigate the etiology and clinical features of children with spontaneous intracranial hemorrhage(SIH).Methods:A total of 213 children with SIH who were admitted to our hospital from January 2012 to December 2017 were enrolled,and their age,etiology,CT findings,and other clinical data were analyzed. Results:SIH mainly occurred in infancy(21.1%)and school age(41.3%),and main etiologies included vascular malformations(44.1%),hemorrhagic cerebral paragonimiasis(23.5%),and coagulation disorder(22.1%). Hemorrhage due to coagulation disorder was the most common etiology in infancy,hemorrhagic cerebral paragonimiasis was the most common etiology in pre-school age,and vascular malformations were the most common etiology in school age and adolescence. Hemorrhage due to coagulation disorder often occurred at multiple anatomical sites,hemorrhage due to vascular malformations often occurred at a single anatomical site and was located in the brain parenchyma and the ventricle,and hemorrhage due to cerebral paragonimiasis was located in the superficial part of the frontal parietal occipital cortex. With the stabilization and absorption of the hematoma,ring-shaped high density with marked edema was observed around the lesion. Conclusion:SIH in children has a characteristic distribution in age and etiology,and hemorrhage due to different etiologies has its own imaging features. The cause of hemorrhage can be identified based on age and imaging findings,and active etiological treatment should be given at the same time to reduce the risk of rebleeding.

关 键 词：脑出血 儿童 病因 计算机断层扫描 

分 类 号：R726.5[医药卫生—儿科]