新生儿感染性脑损伤的早期诊断  

Early diagnosis of neonatal infectious brain injury

作　　者：陆月合 高晓燕[1] Lu Yuehe;Gao Xiaoyan(Department of Neonatology,Maternity&Child Health Care of Guangxi Zhuang Autonomous Region,Nanning 530002,Guangxi Zhuang Autonomous Region,China)

机构地区：[1]广西壮族自治区妇幼保健院新生儿科,南宁530002

出　　处：《中华妇幼临床医学杂志（电子版）》2021年第4期380-386,共7页Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition)

基　　金：广西壮族自治区卫生健康委员会计划课题(Z2016091)。

摘　　要：新生儿感染性脑损伤(IBI)是指围生期各种感染因素直接引起,或由炎症介质间接导致的新生儿神经系统损伤,该病是导致新生儿死亡的主要原因。新生儿IBI发病机制迄今尚未阐明,可能与免疫反应、细胞因子、自由基及兴奋性氨基酸等介导的脑损伤及未成熟少突质细胞易损性等有关。头颅超声、CT、MRI等头颅影像学检查,以及常规脑电图、振幅整合脑电图(aEEG)及神经诱发电位等神经脑电生理学评价,是目前临床早期诊断新生儿IBI的重要手段,可对新生儿脑功能进行整体评估。aEEG可克服全导联视频脑电图限制,实现对新生儿脑功能的监测,具有简便、可床旁连续监测、对检测结果容易分析等优点,而使其成为新生儿IBI评估的重要辅助检测手段。本研究界定的新生儿IBI早期诊断,是指感染发生后1周内对其进行临床诊断。笔者拟就新生儿IBI早期诊断手段的最新研究进展进行阐述,旨在对新生儿IBI的临床诊治提供参考。Neonatal infectious brain injury(IBI)refers to nervous system damage directly caused by various infectious factors or indirectly caused by inflammatory mediators during perinatal period.Neonatal IBI is also the main cause of neonatal death.The pathogenesis of neonatal IBI is still not clear yet,and it may be related to brain injury mediated by immune response,cytokines,free radicals,excitatory amino acids,and vulnerability of immature oligodendrocytes.At present,cranial imaging examinations and neuro-electrophysiological evaluations are important methods for early diagnosis of neonatal IBI.These diagnosis methods can evaluate overall brain functions of neonates,including cranial ultrasound,CT,MRI,and routine electroencephalogram,amplitude-integrated electroencephalogram(aEEG)and nerve evoked potentials detection,etc..aEEG overcomes limitations of full-lead video electroencephalogram and can realize long-term monitoring of neonatal brain functions.It has advantages of simplicity,continuous monitoring at bedside,and easy analysis,which making it an important aid testing method in evaluation of neonatal IBI.The early diagnosis of neonatal IBI defined in this study refers to diagnosis within 1 week after neonatal infection occurrence.This article focuses on describing the latest research progresses in early diagnosis of neonatal IBI,aiming to provide reference for clinical diagnosis and treatment of neonatal IBI.

关 键 词：感染 血传病原体 超声检查 颅神经损伤 放射摄影术 诊断 计算机辅助 脑电描记术 影像学诊断 神经脑电生理 婴儿 新生 

分 类 号：R74[医药卫生—神经病学与精神病学]