131例婴幼儿期自发性颅内出血临床分析  

Spontaneous intracranial hemorrhage in infants:a clinical analysis of 131 cases

作　　者：杨莎 翟瑄[1] 梁平[1] 周渝冬[1] 于增鹏[1] 邹彬[1] 纪文元[1] 周建军[1] YANG Sha;ZHAI Xuan;LIANG Ping;ZHOU Yudong;YU Zengpeng;ZU Bin;JI Wenyuan;ZHOU Jianjun(Department of Neurosurgery,Children's Hospital of Chongqing Medical University,Chongqing,400014,China)

机构地区：[1]重庆医科大学附属儿童医院神经外科,重庆400014

出　　处：《第三军医大学学报》2020年第15期1495-1500,共6页Journal of Third Military Medical University

基　　金：国家自然科学基金面上项目(81971217)。

摘　　要：目的探讨婴幼儿自发性颅内出血的病因、影像学特点、并发症及治疗预后。方法回顾性分析2011-2018年我科收治的131例婴幼儿期(≤3岁)自发性颅内出血患儿的临床诊断、影像学检查结果、并发症、治疗方法及预后。结果本组患儿的出血病因主要包括晚发型维生素K依赖因子缺乏症72例(54.9%)、动静脉畸形16例(12.2%)、血友病15例(11.4%)、不明原因凝血功能障碍9例(6.9%)、海绵状血管瘤5例(3.8%)、缺氧缺血性脑病4例(3.1%)、脑肿瘤卒中3例(2.3%)、脑型肺吸虫病2例(1.5%)、动脉瘤2例(1.5%)、急性白血病1例(0.8%),嗜血细胞综合征1例(0.8%)、颅面血管瘤1例(0.8%)。患儿均由CT或MRI检查明确颅内出血诊断,其中34例疑诊脑血管病变者均行CTA检查,检出率为100%。主要并发症包括抽搐或惊厥发作86例(65.6%)、贫血77例(58.8%)、继发感染46例(35.1%)、脑疝32例(24.4%)、脑水肿28例(21.4%)、脑梗塞27例(20.6%)、脑积水26例(19.8%)、呼吸衰竭14例(10.6%)、惊厥持续状态9例(6.9%)。手术治疗43例,非手术治疗88例。预后评估采用GOS评分,预后良好100例(76.3%)。经二元Logistic回归分析结果显示,并发症中脑水肿(OR=5.794)、脑疝(OR=11.326)和呼吸衰竭(OR=8.028)是患儿预后不良的危险因素(P<0.05)。结论婴幼儿期自发性颅内出血的病因以晚发性维生素K依赖因子缺乏症最常见;出血病因疑诊为脑血管病变者应尽早行CTA检查;并发症以抽搐或惊厥发作最常见;脑水肿、脑疝及呼吸衰竭出现常提示预后不良;该病经积极治疗预后良好。Objective To explore clinical features of the etiology,imaging characteristics,complications and prognosis of spontaneous intracranial hemorrhage in infants.Methods Clinical data of 131 cases of spontaneous intracranial hemorrhage in infants(≤3 years old)admitted to our department from January 2011 to December 2018 were collected and retrospectively analyzed,including their clinical etiology,imaging examination results,complications,treatment methods and prognoses.Results The causes of intracranial hemorrhage in this cohort included delayed vitamin K deficiency(72 cases,54.9%),arteriovenous malformations(16 cases,12.2%),hemophilia(15 cases,11.4%),other unexplained coagulation dysfunction(9 cases,6.9%),cavernous hemangioma(5 cases,3.8%),hypoxic ischemic encephalopathy(4 cases,3.1%),brain tumor stroke(3 cases,2.3%),cerebral paragonimiasis and aneurysm(both 2 cases,1.5%),and acute leukemia,hemophilic syndrome and Sturge-Weber syndrome(all 1 case,0.8%).All cases were diagnosed with intracranial hemorrhage by CT scanning or MRI,and for the 34 cases with suspected cerebrovascular disease,the detection rate of CTA was 100%.The complications included convulsion or seizure(86 cases,65.6%),anemia(77 cases,58.8%),secondary infections(46 cases,35.1%),cerebral hernia(32 cases,24.4%),cerebral edema(28 cases,21.4%),cerebral infarction(27 cases,20.6%),hydrocephalus(26 cases,19.8%),respiratory failure(14 cases,10.6%)and status convulsion(9 cases,6.9%).There were 43 cases undergone surgical treatment,and 88 cases received non-surgical treatment.Glasgow outcome score(GOS)scale indicated that 100 patients(76.3%)achieved a good prognosis.The results of binary logistic regression analysis showed that cerebral edema(OR=5.794),cerebral hernia(OR=11.326)and respiratory failure(OR=8.028)were risk factors for poor prognosis in the infants with spontaneous intracranial hemorrhage(P<0.05).Conclusion The most common cause of spontaneous intracranial hemorrhage in infants is delayed vitamin K deficiency.If the cause of hemorrhage is suspecte

关 键 词：自发性颅内出血 婴幼儿 病因 诊断 预后 

分 类 号：R181.32[医药卫生—流行病学] R729[医药卫生—公共卫生与预防医学]