围产期缺氧性脑损伤患儿神经系统后遗症的早期预测探讨.docVIP

围产期缺氧性脑损伤患儿神经系统后遗症的早期预测探讨 中华儿科杂志 2000年第5期第38卷 论著 作者：周丛乐　姜毅　冯琪　张家洁　刘赛军　崔惠英 单位：周丛乐(100034　北京医科大学第一医院儿科)；姜毅(100034　北京医科大学第一医院儿科)；冯琪(100034　北京医科大学第一医院儿科)；张家洁(北京医科大学学科骨干培养项目学员)；刘赛军(北京医科大学学科骨干培养项目学员)；崔惠英(北京医科大学学科骨干培养项目学员) 关键词：围产期学；脑缺氧；神经系统；预测 　　【摘要】　目的　探讨围产期缺氧性脑损伤患儿神经系统后遗症的早期预测方法。方法　对58例中重度缺氧缺血性脑病患儿进行回顾性分析。将25例有明显神经系统后遗症的患儿和33例无后遗症的患儿进行对照分析，包括围产期缺氧情况、临床神经系统症状出现、持续时间、惊厥发作、脑功能状况及急性期后特征性影像学改变作了对照比较。结果　两组患儿各项比较差异均有显著性。有后遗症组表现：围产期缺氧所致的生后严重抑制状态，神经系统症状出现早，生后6 h内发生者为48％，症状持续10 d以上者占40％，54％的患儿惊厥发生在24 h内，频发病例为85％。脑功能严重紊乱：脑电生理活动表现为广泛、长时间异常放电，有临床下发作或全导低电压，爆发抑制等严重抑制状态。脑氧合功能异常，常有自发的发作性脑氧合降低现象。88％的患儿在急性期后影像学检查表现为广泛的脑实质性病变或脑室及脑室周围病变。结论　综合分析围产儿缺氧后临床的抑制状况、神经系统症状发生、持续时间、惊厥发作情况、脑功能状态及影像学直观的脑内晚期病变特征，对早期预测神经系统后遗症有重要参考价值。 The early prediction of the prognosis of perinatal hypoxic brain damage ZHOU Congle，JIANG Yi，FENG Qi，et al, 　　Department of Pediatrics，First Hospital, Beijing Medical University, Beijing 100034,China 　　【Abstract】　Objective　To find out ways of early prediction of the prognosis of perinatal hypoxic brain damage. Methods　Data of 58 patients suffered from moderate to severe hypoxic-ischemic encephalopathy（HIE） were retrospectively analyzed. Of these patients，25 had obvious nervous system sequelae compared with 33 controls who showed no nervous system sequelae. Factors related to sequelae included history of hypoxia，onset time and duration of nervous system symptoms，state of convulsion and brain function（EEG，near infrared spectroscopy），and image changes after the acute phase of the disease. Results　Marked differences between the study and control groups were observed. The study group showed severe inhibited state after birth, early onset of nervous system symptoms and 48％ occurrence within 6 hours after birth. Symptoms lasted for more than10 days in 40％，convulsion occurred within 24 hours in 54％，and 85％ showed frequent onset. It was revealed that severe brain function disorders（EEG）, including multifocal long time abnormal discharge，subclinical discharge, low voltage，burst suppress