30例新生儿脑梗死围生期因素的分析

目的:探讨新生儿脑梗死(NCI)围生期发病因素及其发病情况,便于早期防治,降低本病的发生率。方法:总结30例确诊病例的临床特征、影像学表现,进行围生期因素和其它可能病因分析。结果:1年内本院发现6例NCI,占同期住院患儿0.6‰。产前与产时孕妇存在高危因素占83.3%,新生儿出生窒息占30.0%。NCI合并左向右分流先心病36.7%,合并卵圆孔未闭26.7%。临床早期50.0%患儿出现阵发性惊厥,其中80.0%发生于生后72 h内。63.3%患儿缺乏定位体征,且伴有不同程度意识改变、肌张力异常和(或)原始反射异常等非特异性神经系统表现。颅脑CT平扫或MRI均有阳性发现,75.0%发生于左侧大脑中动脉,而且左侧发生多与右侧,分别为73.9%与26.1%。结论:新生儿脑梗死并不少见,是新生儿惊厥早期病因之一,与围生期孕妇的高危因素、新生儿窒息以及先心病等疾病密切相关,及时针对性选择头颅MRI或CT检查是早期确诊主要方法,防治围生期各种高危因素对降低NCI的发病率至关重要。

Analysis on perinatal factors of 30 neonates with cerebral infarction

Objective:To explore the epidemic factors and the incidence of neonatal cerebral infarction during perinatal period,in order to prevent and treat early,reduce the incidence of the disease. Methods:The clinical features and imaging appearances of 30 neonates with confirmed cerebral infarction were summarized,the perinatal factors and other probable causes were analyzed. Results:Within one year,6 neonates with cerebral infarction were found in the hospital,accounting for 0.6‰ of hospitalized neonates.83.3% of the pregnant women had high risk factors before and during delivery,the proportion of neonatal birth asphyxia was 30.0%.36.7% of the neonates with cerebral infarction combined with left to right shunt congenital heart disease,and 26.7% of the neonates with cerebral infarction combined with patent foramen ovale.Paroxysmal seizures occurred in 50.0% of the neonates in preliminary clinical stage,and 80.0% of them occurred within 72 hours after birth;63.3% of the neonates lacked positioning signs and with non-specific nervous system manifestations including consciousness change at different levels,dystonia and(or) abnormal primary reflex.Positive findings were found through cerebral CT scan or MRI,75.0% of the neonates occurred at left middle cerebral artery,and the positive rate at left middle cerebral artery(73.9%) was higher than that at right middle cerebral artery(26.1%). Conclusion:Neonatal cerebral infarction is not rare,which is one of the early causes of neonatal cerebral infarction,and related to high risk factors of pregnant women during perinatal period,neonatal asphyxia and congenital heart disease closely,timely and targeted cerebral CT scan or MRI are the main methods of early diagnosis of neonatal cerebral infarction,preventing and treating all kinds of high risk factors during perinatal period is very important for decrease of neonatal cerebral infarction incidence.