经颅彩超筛查对高危儿脑损伤的早期诊断价值

[目的]探讨经颅彩超筛查对高危儿脑损伤的早期诊断价值.[方法]选择自2010年10月至2012年8月在本院出生的脑损伤高危儿820例,均于生后1~3 d常规经颅彩超筛查,对超声诊断阳性而未出现临床症状者,经临床早期干预5~7 d复查,对有临床症状者同期给予CT对照检查.[结果]820例高危儿有61.2%(502/820)有不同程度脑损伤,包括颅内出血(intracranial hemorrhage,ICH)组336例和缺氧缺血性脑病(hypoxic-ischemic encephalopathy,HIE)组166例;其中尚未出现临床症状的轻度脑损伤约37.3%(187/502),经早期干预治疗5~7 d复查,约98.4%(184/187)恢复正常,仅2例出现室管膜下假性囊肿,1例进展为Ⅲ级ICH;有临床症状者同期头颅彩超和CT诊断结果比较无显著差异(P>0.05).[结论]头颅彩超无创、便捷、重复性好,脑损伤高危儿实施常规头颅彩超筛查,能及早发现无临床症状者的病变,避免漏诊,降低围生期死亡率及脑损伤后遗症发生的风险,提高生存质量.     

住院早产儿脑室内出血的早期诊断

目的:调查不同胎龄住院早产儿脑室内出血(intraventricular hemorrhage,IVH)的发生率。方法:对2003年1月至2005年12月我院新生儿重症监护室(NICU)住院的438例早产儿(生后1周内),应用MEGAS-DU4彩色超声诊断仪进行床边颅脑超声检查,并做好相关记录,调查不同胎龄早产儿IVH的发生率。结果:438例早产儿平均胎龄(31.80±2.87)周,平均出生体重(1836.98±543.95)g,平均颅脑超声初次检查时间(2.91±0.81)d。总的IVH的发生率为40.41%(177/438),其中IVH(Ⅰ级)发生率为26.71%(117/438),IVH(Ⅱ级)发生率为8.68%(38/438),重度IVH(Ⅲ级以上)发生率为5.02%(22/438)。61.02%(108/177)的IVH早产儿无明显临床症状,38.98%(69/177)的IVH早产儿出现临床症状,包括反应低下、激惹、反复呼吸暂停、紫绀、抽搐等。资料显示IVH主要发生在胎龄偏小和出生体重低的早产儿。结论:所有住院早产儿在生后1周内均应进行颅脑超声检查,以便筛选出无症状的IVH患儿,及早诊治,减少脑出血性损伤。     

经颅多普勒超声在犬腹部爆炸伤后脑血管损伤中的应用

目的 利用经颅多普勒超声（TCD）技术对犬腹部爆炸伤后脑血管损伤进行评价。方法 制作犬腹部爆炸伤动物模型,分别伤后不同时相点用TCD仪探测犬大脑中动脉（MCA）血流速度,计算搏动指数（PI）、阻力指数（RI）、同时进行MCA的病理形态学观察。结果 伤后即刻MCA的血流速度显著减慢（P＜0．01）,伤后3h最低,以后收缩峰血流速度（Vs）逐渐回升,至伤后24h基本接近伤前水平,而舒张期末血流速度（Vd）始终维持在较低水平。PI、RI在伤后即刻明显升高（P＜0．01）,且在24h内持续维持在高水平。MCA的形态学改变以内支、内膜损伤和动脉平滑肌构筑紊乱为主。结论 伤后Vd的持续偏低和PI、RI持续偏高可能是脑血管间接受损的特征性表现,利用TCD技术可间接推断脑血管受损情况。     

超声在新生儿常见脑损伤中的应用进展

脑损伤是导致新生儿不良神经发育结局的主要原因,早期诊断及治疗对降低新生儿致死、致残率,改善预后至关重要.颅脑超声是近年来评估新生儿脑形态学的重要诊断工具,尤其适用于危重患儿.本文就颅脑超声及其新技术在新生儿常见脑损伤中的应用进展进行综述.     

经颅彩色双功超声检测高血压患者的脑血管反应性

目的:了解不同程度高血压对脑血管血流储备功能的损害。方法:用经颅彩色双功超声(TCCD)检测了33例I级原发高血压(EH)患者(A组),30例II级或III级EH患者(B组),以及38例正常对照组(C组)的安静状态下及屏气25s后大脑中动脉(MCA)的平均血流速度(Vmmca)及其彩色血流宽度(Dmca)。用如下公式计算MCA的血流量(BFVmca):BFVmca(ml/min)=(Dmca/2)2·π·Vmmca·60。并把屏气25s后BFVmca的相对增加率作为评价脑血管CO2反应性的观察指标。结果:BFVmca的相对增加率在A组、B组及C组分别为29.07%±3.79%,28.12%±3.97%和31.19%±3.21%。I级EH组的脑血管CO2反应性较正常对照组显著减低(P<0.05, II级或III级EH组较正常对照组减低更为明显(P<0.01)。结论:轻度高血压患者脑血管血流储备能力已明显受损,且随高血压程度的增高损害进一步加重。     

早产儿1122例脑室周围-脑室内出血发生率及其高危因素的分析

背景:脑室周围-脑室内出血是早产儿死亡和伤残的重要原因,大样本调查资料可为早产儿脑室周围-脑室内出血发生率及其高危因素的分析提供支持性数据。目的:认识早产儿脑室周围-脑室内出血的发生率及其高危因素。设计:调查分析。单位:华中科技大学同济医学院同济医院,首都医科大学附属北京妇产医院,河北省秦皇岛市妇幼保健院。对象:选择2002-01/2005-08在北京妇产医院和秦皇岛市妇幼保健院出生,并于生后1周内作头颅超声检查的早产儿1122例,男594例,女528例,胎龄26.3～36.8周,出生时体质量(850～4500)g。方法:1122例早产儿于生后1周内常规作头颅超声检查,并记录相关围产因素。使用仪器为NewPhilips5500型和GEHealthcareLogiq400型超声诊断仪(分别由荷兰Philip公司和美国GE公司生产)。主要观察指标:脑室周围-脑室内出血相关因素分析结果。结果:纳入早产儿1122例全部进入结果分析。其中619例发生了不同程度的脑室周围-脑室内出血(55.2%);重度出血占出血总数的17.8%。小胎龄、低体质量、机械通气、低血糖、高碳酸血症、高乳酸血症、酸中毒、缺氧、血液凝固机制异常等为早产儿颅内出血的主要高危因素,产前使用地塞米松可降低小胎龄早产儿颅内出血发生率。结论:早产儿出生后常规作头颅超声检查,早期发现并定期随访对减少神经系统后遗症有重要意义。     

经颅多普勒超声评估颈内动脉严重狭窄或闭塞患者的侧支循环代偿能力

目的探讨经颅多普勒超声（TCD）评估颈内动脉严重狭窄或闭塞患者的侧支循环代偿能力。方法对60例一侧颈内动脉严重狭窄或闭塞患者,根据临床上有无脑缺血和神经功能障碍体征,将患者分为症状性严重狭窄或闭塞组（44例）和无症状性严重狭窄或闭塞组（16例）。TCD柃测Willis环和眼动脉的侧支循环通路。结果TCD显示54例前交通动脉侧支开放,31例后交通动脉侧支开放,15例眼动脉侧支开放。3例症状性严重狭窄或闭塞患者未发现侧支循环。无症状性严重狭窄或闭塞患者的大脑中动脉平均血流速度高于症状性闭塞患者（P〈0．01）。结论TCD有助于了解颈内动脉系统动脉严重狭窄或闭塞患者的侧支循环代偿能力,为评估治疗效果和预后提供重要的客观依据。     

缺血性脑卒中患者颈动脉超声与颅底大动脉经颅多普勒的改变

目的：研究颈动脉及颅内血管的功能状况，为缺血性脑卒中预防及治疗提供依据。方法：110例缺血性脑卒中患者行颈动脉彩色多普勒超声、颅底大动脉经颅多普勒超声检查。结果：颈动脉超声异常率达84．5％，颅底大动脉经颅多普勒超声异常率达71．8％。结论：对颈动脉和颅内动脉的联合检查有助于评价患者侧支循环状况，是缺血性脑卒中病情轻重、预后的关键因素。     

经颅多普勒超声的临床应用与研究进展

经颅多普勒超声(TCD)能无创、快速地对脑血流动力学进行检查和监测,被称为脑血管的"听诊器".目前,TCD不仅用于脑血管痉挛或狭窄等的检查,还被用于卵圆孔未闭、偏头痛等研究.本文就TCD的临床应用价值进行综述,旨在扩大其应用范围.     

经颅多普勒超声在诊断颈内动脉重度狭窄或闭塞中的临床价值

目的探讨研究经颅多普勒超声(TCD)对颈内动脉重度狭窄或闭塞的诊断价值。方法 21例颈内动脉重度狭窄或闭塞患者,行TCD检查后1周内行DSA或磁共振血管成像检查,将其颈内动脉影像学结果进行比较。结果 TCD对颈内动脉狭窄的敏感性为92.00%,特异性为94.12%,假阳性率为5.88%,假阴性率为8.00%,诊断准确率为92.86%;且TCD对颈内动脉重度狭窄或闭塞的诊断准确率为80.95%。将正常的血管剔除后,其对狭窄程度的诊断符合率为69.23%。结论 TCD可作为颈内动脉狭窄的一种筛查手段,但对于颈内动脉狭窄程度的判断,TCD仍存在局限性。     

早期康复训练治疗早产儿脑损伤的临床研究

目的探讨早期康复训练对早产儿脑损伤的治疗效果。方法脑损伤早产儿101例,分为干预组45例和对照组56例。对照组仅给予药物治疗,干预组在药物治疗同时进行早期康复训练。在患儿3、6、9、12月龄时进行发育评价。结果纠正胎龄40周时新生儿行为神经测定（NBNA）评分两组间无显著性差异（P＞0.05）;3月龄时两组智力指数（MI）和发育商（DQ）无显著性差异;9、12月龄时有非常显著性差异（P＜0.01）;两组后遗症发生率有显著性差异（P＜0.05）。结论早产儿脑损伤恢复期给予早期康复训练能促进其神经心理发育,降低后遗症发生。     

Brain ultrasound in Canavan disease

Canavan disease (MIM 271900) is a rare autosomal recessive leukodystrophy due to mutations in the ASPA gene (MIM 608034) and characterized by a clinical onset at 3–5 months of life, macrocephaly and poor head control, weak cry and suck, development regression and hypotonia. Here, we report cranial ultrasound findings at birth and at 4 months of age in a patient affected with Canavan disease. The comparison of our sonographic data with few other cases in literature allows us to suggest a characteristic pattern in Canavan disease.     

重型颅脑损伤患者医院感染分析及其护理

目的　为探讨重型颅脑损伤后医院感染危险因素 ,以采取有效控制措施。方法　回顾性汇总分析 1 999年 1月～ 2 0 0 3年 1 2月重型颅脑损伤监测资料。结果　重型颅脑损伤医院感染发生率为 (2 9.33% ) ,例次率为 (35 .5 8% )。感染部位以肺部感染 (4 8.6 5 % ) ,尿路感染 (2 3.6 5 % )多见。病原菌以G-杆菌为主。单因素分析表明 ,重型颅脑损伤患者医院感染发生与侵入性操作 (OR :2 7.82 ,95 %CI:1 7.86～ 4 1 .5 3)、脑出血 (OR :2 1 .75 ,95 %CI :1 5 .78～ 4 1 .1 2 )、平均住院日 (OR :5 .76 ,95 %CI:4 .85～ 8.74 )、血糖 (OR :4 .5 8,95 %CI :1 .98～ 3.97)等因素有关。结论　对病情重 ,住院时间长 ,应用抗菌药物治疗和实施了侵入性诊疗操作的重症颅脑损伤患者 ,应采取相应护理对策 ,预防医院感染的发生。     

Indications for routine cranial ultrasound scanning in the nursery

Cranial ultrasonography provides important diagnostic information in neonates. The clinical indications for routine scanning in newborn infants, however, are not established. The purpose of this study is to determine the incidence of cranial pathology detectable by ultrasound in certain clinical states in the neonate. We reviewed the scans and clinical states of 1,031 neonates born between April 1981 and February 1985. We found term infants with dysmorphic features to have the highest incidence of neuropathology (46%), followed by term infants born with macrocephaly (33%), preterm infants (26%), term infants with seizures (26%), and term infants with 1- and 5-min Apgar scores less than 7 (13%). We found a lower incidence (less than 5%) of abnormal CNS findings in the nonasphyxiated term infants with split sutures, cephalohematoma, abnormal neurologic examination, and idiopathic jitteriness. Based on our findings we have concluded that it is important to scan routinely all premature infants, term infants with dysmorphic features, macrocephaly, or seizure disorder, and infants with 1- and 5-min Apgar scores less than 7; routine scanning of term infants with split sutures, cephalohematoma, abnormal neurological examination, or idiopathic jitteriness is not indicated.     

超声诊断新生儿缺血缺氧性脑病及其合并心肌损伤的临床分析

ABSTRACT Objective To explore the values of cranial ultrasonography (cUS) on diagnosis of neonatal encephalopathy and analyze the incidence rate of encephalopathy with myocardial damage. Methods A retrospective study was conducted at Neonatal Intense Care Unit of department of Pediatrics in the Fourth Hospital of Hebei Medical University in China from January to June 2016. 45 premature infants and 40 term infants were selected. All these neonates received cUS to detect intracranial structure and the brain blood flow. The incidence rate of encephalopathy with myocardial damage in the two groups were compared. Results 32 cases of premature and 29 cases of term were clinically confirmed encephalopathy. According to the results of cUS, 24 cases of premature group and 15 cases of term group were abnormal.The incidence rate of myocardial damage in premature with encephalopathy was higher than its in term infants.There was significant difference in the two groups (P<0.05). Conclusions cUS is of great value on diagnosing of neonatal encephalopathy. Neonates, especially premature, in the occurrence of encephalopathy can be combined with myocardial damage,which should be highly valued.     

Relationship of Neonatal Cerebral Blood Flow Velocity Asymmetry with Early Motor,Cognitive and Language Development in Term Infants

The objective of this study was to examine the relationships of Doppler cerebral blood flow velocity (CBFV) asymmetry measures with developmental outcomes in term infants. Doppler CBFV parameters (peak systolic velocity [PSV] and mean velocity [MV]) of the bilateral middle cerebral arteries of 52 healthy term infants were prospectively examined on postnatal days 1–5, and then their motor, cognitive and language development was evaluated with the Bayley Scales of Infant and Toddler Development, Third Edition, at 6, 12, 18 and 24 months of age. The left CBFV asymmetry measure (PSV or MV) was calculated by subtracting the right-side value from the left-side value. Left CBFV asymmetry measures were significantly positively related to motor scores at 6 (r = 0.3–0.32, p < 0.05) and 12 (r = 0.35, p < 0.05) months of age, but were not related to cognitive or language outcome. Thus, the leftward hemodynamic status of the middle cerebral arteries, as measured by cranial Doppler ultrasound in the neonatal period, predicts early motor outcome in term infants.     

腹腔感染致休克患者行损伤控制性治疗的护理

目的探讨腹腔感染导致感染性休克患者行损伤控制性治疗的护理方法。方法回顾性分析并总结2007年12月至2011年1月成都军区总医院普外胃肠科收治的32例腹腔严重感染致休克患者的临床资料。结果经损伤控制性治疗与护理,32例患者中30例患者痊愈出院、2例患者由于多器官功能衰竭死亡。结论腹腔感染导致休克的患者应用损伤控制性策略指导护理可以早期发现休克症状,早期进行抗休克治疗,有效腹腔引流,从而维护重要器官功能、控制感染、促进感染灶的消除,最终降低患者创伤程度、提高救治成功率。     

实时剪切波弹性成像评价新生儿脑损伤

【目的 应用实时剪切波弹性成像(SWE)量化评价新生儿脑损伤不同部位杨氏模量值的变化,以提高新生儿脑损伤诊断的准确性。 资料与方法 选择在我院超声科行颅脑超声检查的新生儿134例,按照胎龄分为早产儿38例（＜37周）、足月儿96例（≥37周）两组。根据新生儿缺血缺氧性脑病（HIE）诊断标准,又将足月儿分为正常组和HIE组,根据早产儿脑白质损伤超声诊断标准,将早产儿分为正常组和脑白质损伤组。对新生儿的顶叶、丘脑以及小脑行剪切波弹性成像检查,并测出相对应杨氏模量值,来比较新生儿脑损伤不同部位的杨氏模量值是否有差别。 结果 1.顶叶、丘脑、小脑的图像采集成功率分别为89.56%、90.30%、78.36%;2.足月正常组丘脑及小脑的杨氏模量值大于足月HIE组（P均＜0.05）; 3.早产正常组顶叶及小脑的杨氏模量值大于早产脑白质损伤组（P均＜0.05）; 结论 SWE可以定量评价大脑、丘脑和小脑硬度,为新生儿脑损伤提供诊断依据。 】     

Usefulness of Cranial Ultrasound for Detecting Neonatal Middle Cerebral Artery Stroke

Magnetic resonance imaging is the gold standard technique in establishing the diagnosis of neonatal arterial ischemic stroke (NAIS). The diagnostic value of cranial ultrasound scanning in this clinical context is controversial. We aimed to assess the current sensitivity of the cranial ultrasound scan (CUS) in detecting NAIS, as this issue has not been well described in the literature. Newborns with NAIS diagnosed by magnetic resonance imaging between 2010 and 2016 were included. All CUSs were blindly analyzed retrospectively by a neonatologist expert in neuroimaging and compared with the findings of non-expert evaluators recorded on medical charts immediately after performing the evaluation. The overall sensitivity of CUS in detecting an imaging finding suggestive of NAIS was 87% (95% confidence interval (CI): 79%–95%) for an expert evaluator, but declined to 72% (61%–83%) when performed by a non-expert evaluator (p 0.002). Sensitivity was 83% and 61% in the first 24 h and 86% and 66% at 24–48 h for expert and non-expert evaluators, respectively (p < 0.05). CUS has higher sensitivity than previously reported in the detection of a NAIS, for both expert and non-expert evaluators. These findings may be explained by the advanced technology of new ultrasound equipment. Expertise in performing CUS is useful, particularly in the first 48 h after clinical debut.