新生儿缺血缺氧性脑病CT随访探究.docVIP

新生儿缺血缺氧性脑病CT随访探究 　 作者：梅海英，涂嘉民，张元宪 【摘要】 目的：研究新生儿缺血缺氧性脑病(HIE)的发展规律及程度与预后的关系。方法:收集有围产期窒息史,头颅CT诊断为不同程度的HIE，分别于3个月、6个月及1 a进行CT和智力发育随访复查的患者51例。结果：3个月时50%病例有CT异常表现，大部分是外部性脑积水，其中27.3%病例有神经系统症状和体征；6个月复查，35.5%有CT异常表现，其中35.5%有神经系统症状和体征；1岁后约12.5%有异常CT表现,表现为局限性脑软化和脑萎缩。结论：HIE所致脑实质低密度影在出生后3个月内吸收消失；HIE的预后与CT分度密切相关，轻度预后良好。中、重度预后差。早产窒息儿颅内病变严重，如伴有脑实质出血，预后差；HIE在3个月复查时，50%有头颅CT表现异常，大部分为外部性脑积水，1岁时外部性脑积水愈合。 【关键词】 新生儿；脑缺氧；X线计算机体层摄影 　　CT Followup Survey of Neonatal Hypoxic Ischemic Encephalopathy 　　Abstract: Objective To study the evolution of neonatal hypoxic ischemic Encephalopathy(HIE). Methods 51 cases of asphyxial perinatal neonates were selected,and HIE was diagnosed on CT . Followup study was carried out at the 3rd, 6th month and one year of age. Results At 3rd month 50% cases were abnormal on CT, mostly showing externel hydrocephalus 27.3% cases had clinical manifestations of nervous system. At 6th, 35.5% cases were abnormal on CT.35.5% cases had clinical manifestations of nervous system. After one year,about 12.5% cases had abnormal CT with localiaed cerebral softening and atrophy , and corresponding clinical manifestationg. Conclusion Cerebral low density lesion was absorbed in 3 months; Prognosis of HIE was closely related to the degree of abnormal manifestations on CT. Intracranial lesions were more serious in asphyxial premature ones .If there were bleeding or bleeding in ventricles, the prognosis would be poor; At 3rd month, about half of the cases had abnormal CT, mostly showing extermely hydrocephalus (HE) .After one year, He was recovered. 　　Key words: Neonate; Hypoxic encephalopathy; CT 　　新生儿缺血缺氧性脑病(HIE)仍然是严重危及围产期新生儿死亡和幸存儿神经系统发育障碍，智能落后的主要原因。有关HIE的临床和CT诊断论述较多，但HIE追踪观察和预后方面的研究报告甚少。 　　1 材料与方法 　　1.1 临床资料 收集有围产期窒息史，头颅CT诊断为不同程度的HIE，又作CT和智力发育随访复查的患者51例，其中男性49例，女性2例。足月产44例，早产儿7例，自然分娩45例，剖宫产6例，临床表现主要有神志过度兴奋、反应迟钝、嗜睡，甚至昏睡。原始反射减弱或消失，肌张力减低或肌肉松软、惊厥等。按韩玉昆等［1］的HIE分度标准，临床属轻度者14例，中度23例，重度14例。初次头颅CT检查：出生后30 min～18 d，平均4 d，3 d以内45例，4 d以上6例。CT主要表现有脑实质内低密度灶，脑室受压变窄，严重者可见反转征。参照韩玉昆等［1］和Lupton B