单中心新生儿脑积水10年临床资料回顾性分析  

Neonatal hydrocephalus:single-center 10-year experiences

作　　者：张艺 胡晓静 黄盼盼 李丽玲 肖甜甜 盛伟 周文浩 黄国英 Zhang Yi;Hu Xiaojing;Huang Panpan;Li Liling;Xiao Tiantian;Sheng Wei;Zhou Wenhao;Huang Guoying(Department of Neonatology,National Children's Medical Center/Children's Hospital of Fudan University,Shanghai 201102,China)

机构地区：[1]复旦大学附属儿科医院新生儿科,国家儿童医学中心,上海201102

出　　处：《中华新生儿科杂志（中英文）》2023年第7期395-400,共6页Chinese Journal of Neonatology

基　　金：国家重点研发计划(2021YFC270100,2016YFC1000500)。

摘　　要：目的分析新生儿脑积水的临床特点。方法通过检索电子病历系统,回顾性分析2010年1月至2019年12月复旦大学附属儿科医院新生儿科收治的脑积水患儿临床资料,根据是否足月、不同病因及治疗方式进行分组,比较各组临床特征及短期结局。结果共纳入脑积水患儿223例。早产儿136例(61.0%),足月儿87例(39.0%),早产儿组颅内出血后脑积水比例高于足月儿组(P<0.001)。原发性脑积水58例(26.0%),颅内出血后脑积水82例(36.8%),颅内感染后脑积水48例(21.5%),出血合并感染后脑积水35例(15.7%),颅内出血组围产期窒息、出生时急救复苏、生后3 d内气管插管比例高于其他组(P<0.05);颅内感染组合并新生儿败血症、原发性组合并动脉导管未闭、颅内出血组合并呼吸系统疾病比例高于其他组(P<0.05)。非手术治疗137例(61.4%),临时性引流48例(21.5%),永久性分流37例(16.6%),行颅内血肿清除术1例(0.4%),原发性组及颅内出血组行永久性分流术后好转率高于临时性引流和非手术治疗(P<0.001)。结论新生儿脑积水的主要病因为颅内出血及颅内感染;颅内出血后脑积水早产儿比例高,不同病因引起的脑积水合并不同的临床问题;孕产期母婴保健、预防新生儿败血症及颅内出血是预防脑积水的要点;治疗方式的选择尚需积累更多经验。Objective To study the past 10 years'experiences of neonatal hydrocephalus in a single-center.Methods From January 2010 to December 2019,clinical data of infants with hydrocephalus admitted to Neonatology Department of our hospital were retrospectively analyzed.The infants were assigned into different groups according to gestational age,different etiologies and treatments.Their clinical characteristics and outcomes were compared.Results A total of 223 infants with hydrocephalus were included.136(61.0%)infants were in the preterm group and 87(39.0%)in the full-term group.The incidence of post-intracranial hemorrhage(ICH)hydrocephalus in preterm infants was significantly higher than full-term infants(P<0.001).According to the etiologies,58 infants(26.0%)had congenital hydrocephalus(congenital group),82 cases(36.8%)developed post-ICH hydrocephalus(ICH group),48 cases(21.5%)had post-CNS-infection hydrocephalus(infection group)and 35 cases(15.7%)had post-ICH+CNS-infection hydrocephalus(ICH+infection group).The incidences of perinatal asphyxia,neonatal resuscitation and endotracheal intubation within 3 d after birth in the ICH group were significantly higher than the other groups(P<0.05).Among the four groups,the infection group had the highest incidence of neonatal sepsis,the congenital group had the highest incidence of patent ductus arteriosus and the ICH group had the highest incidence of respiratory diseases(all P<0.05).137 cases(61.4%)received non-surgical therapy,48 cases(21.5%)had temporary drainage,37 cases(16.6%)with permanent shunt and 1 case(0.4%)intracranial hematoma removal.The congenital group and ICH group with permanent shunt showed significantly higher rate of improvement than temporary drainage group and non-surgical group(P<0.001).Conclusions The main etiologies of neonatal hydrocephalus are ICH and CNS infection.The incidence of post-ICH hydrocephalus in premature infants was quite high.Hydrocephalus of different etiologies have different comorbidities.Maternal and infant care during pregnancy and

关 键 词：新生儿 脑积水 颅内出血 颅内感染 脑室-腹腔永久性分流 

分 类 号：R722.1[医药卫生—儿科]