足月新生儿颅内出血手术治疗及随诊分析

目的探讨新生儿颅内出血(neonatal intracranial hemorrhage,NICH)的高危因素、临床表现、手术疗效及预后,以提高认识、早诊断、早治疗。方法2012年6月至2014年7月,暨南大学第一附属医院收治的NICH足月患儿中,4例接受手术治疗并定期随诊至学龄前期。采用回顾性分析的方法,记录这4例患儿围产期相关情况、临床表现、实验室检查、手术治疗情况及预后。结果4例患儿均存在围产期相关高危因素(脐带异常、胎心下降、头盆不称、阴道试产失败转剖宫产、羊水污染等);均不以神经系统异常为首发症状。颅脑超声检查均有阳性发现,头颅CT进一步确诊了颅内出血的类型和出血量,病例1双侧侧脑室及第三脑室增宽;病例2头皮下血肿及硬膜下出血,颅骨移位;病例3硬膜外血肿;病例4脑实质内出血脑疝。3例患儿急诊行开颅血肿清除术,1例患儿保守治疗3 d后行侧脑室转孔引流术。4例患儿出院后随访至学龄前,预后均良好。结论足月儿NICH与围产期因素有关,早期临床表现缺乏特异性,建议尽早行头颅超声筛查和CT确诊,及时手术治疗可以改善预后。

Neurosurgical management and follow-up for intracranial hemorrhage in term neonates

Objective To explore the high-risk factors, clinical manifestations, surgical efficacy and prognosis of intracranial hemorrhage in newborns to improve cognition and early diagnosis and treatment. Methods From June 2012 to July 2014, in the admitted full-term newborns who were diagnosed as neonatal intracranial hemorrhage(NICH) in The First Affiliated Hospital of Ji’nan University, four cases received surgical treatment and regular follow-up until preschool. The perinatal situation, clinical manifestation, laboratory examination, surgical treatment and prognosis of the four cases were analyzed retrospectively. Results The four cases all had perinatal high-risk factors(abnormal umbilical cord, decreased fetal heart rate, cephalopelvic disproportion, cesarean section due to failure of vaginal delivery, amniotic fluid contamination, etc.). The first symptom was not nervous system abnormality in the four cases. In brain ultrasonography, they all showed positive findings. The type and amount of intracranial hemorrhage were further confirmed by CT. Case 1: bilateral lateral ventricles and third ventricles were widened. Case 2: subdural hematoma and subdural hemorrhage, and cranial displacement. Case 3: extradural hematoma. Case 4: intracerebral hemorrhage combined with cerebral hernia. Three cases underwent emergency treatment and got removal of hematoma by craniotomy. Case 1 had conservative treatment for three days, then accepted the lateral ventricle drainage. Four children were followed up after discharge until preschool, and they all had satisfactory prognosis. Conclusions The NICH of full-term newborns may be related to perinatal factors. The early clinical manifestations lack specificity. Early head ultrasound screening and CT diagnosis are recommended, and timely surgical treatment can improve the prognosis.