早产儿颅内出血的头颅CT特点与临床表现分析

目的: 通过分析 337例早产儿头颅CT检查结果, 了解早产儿颅内出血 (intracranialhemorrhage, ICH) 的发病情况、头颅CT与临床表现特点。方法: 337例早产儿于生后 3~7d行头颅CT检查, 其中 98例存在ICH, 收集其临床资料, 分析出生体重、胎龄与ICH类型的关系, 分析ICH患儿临床表现特点与转归情况。结果: 98例ICH早产儿 (检出率 29 .1% ) 中有围产期因素者 69例 (70 .4% ); 出血类型: 蛛网膜下腔出血 (subarachnoidhemorrhage, SAH) 62例 (63 .3% ), 室管膜下-脑室内出血 (subependymal/intraventricularhemorrhage, SEH/IVH) 28例 (28. 6% ), 脑实质出血 (intraparenchymalhemorrhage, IPH)8例 (8. 2% ), 出生体重>1 500g、胎龄≥34周者多发生SAH, 出生体重<1. 000g、胎龄<32周者发生SHE/IVH较多; 临床表现: 有症状者 72例 (73. 5% ), 其中以兴奋症状为主者 16例, 以抑制状态为主者 48例, 先短暂兴奋后转为抑制状态者 8例; 转归: 治愈及好转 68例, 死亡 28例, 自动出院 2例, 病死率 28. 6%。结论: 早产儿ICH多数有围产期因素, 出血类型与出生体重、胎龄存在一定关系, 临床表现多样, 易漏诊, 病死率高, 故早产儿常规进行头颅CT检查是必要的。

Analysis of cranial CT features and clinical manifestations in premature infants with intracranial hemorrhage

Objective:Through analyzing the cranial CT results in 337 premature infants, to investigate the morbidity, cranial CT types and the clinical features of the premature infants with intracranial hemorrhage (ICH).Methods:337 premature infants were made cranial CT scan within 3 to 7 days after birth, in which 98 cases had gotten ICH.The clinical data of these 98 cases with ICH were collected and the relationship of birth weight, gestational age with the hemorrhage type and the clinical features and the prognosis were analyzed.Results:The detective rate of ICH in these 337 premature infants was 29.1%.Among 98 cases with ICH, 69 cases(70.4%)had perinatal factors and others had not. 62 cases(63.3%)had subarachnoid hemorrhage(SAH), 28 cases(28.6%)had subependymal /intraventricular hemorrhage(SEH/IVH)and 8 cases(8.2%)had intraparenchymal hemorrhage(IPH).For those infants' birth weights more than 1 500 g and /or gestational ages more than 34 weeks, the chances of having SAH were higher than that of having other ICH types. However, for those ones' birth weights lower than 1 000 g and/ or gestational ages smaller than 32 weeks, the chances of having SEH/ IVH were higher than that of having other types.There were 72 cases(73.5%)with clinical manifestations, among which 16 had irritable symptoms, 48 had inhibiting symptoms and 8 had transient inhibiting symptoms firstly continued with irritable symptoms later.68 cases were healed or improved, 28 cases were dead and 2 cases were discharged automatically.The fatality rate was 28.6%.Conclusion:In premature infants with ICH, there were perinatal factors mostly and the hemorrhage types were related to the birth weight and gestational age.The clinical manifestations were verified to be easily missed diagnosis and the fatality rate was high. So it was necessary to make cranial CT scan in premature infants routinely.