新生儿缺氧缺血性脑病46例临床与预后分析

目的:通过分析新生儿缺氧缺血性脑病(HIE)的临床分度与窒息的程度,了解HIE的预后对体格发育及智能发育的影响。方法:对46例经头颅CT及临床诊断为HIE的患儿进行官内窘迫,临床分度及预后的分析。从随访中了解HIE对患儿体格发育及智力发育的影响。结果:随访35例患儿,轻度HIE预后良好,中、重度有可能发生后遗症。结论:加强围生期保健,提高产科质量,进行新法复苏及复苏后处理是降低HIE发病率的关键。早期治疗、早期评分、早期随访、早期干预是改善重度HIE预后的重要环节。     

婴儿抚触对新生儿缺氧缺血性脑病预后的影响

目的探讨婴儿抚触改善新生儿缺氧缺血性脑病(HIE)预后的效果.方法将HIE患者分组,治疗组60例,予对症、改善内环境、脑营养等常规治疗同时予婴儿抚触;对照组55例,只给予常规治疗.2组治疗后行新生儿行为神经测定(NB-NA)及追踪随访.结果治疗组中、重度HIE患者的治疗后NANB评分为35.23±2.26分和32.82±3.63分,高于对照组,差异有显著性(P＜0.05).治疗组按进行测查精神发育指数(PD1)和运动发育指数(MD1)测查,1岁是101±9和98±11,2岁是110±13和105±9,高于对照组,差异有显著性(P＜0.05).结论婴儿抚触可改善HIE患者的预后,有助HIE患者的精神体格发育,减少神经后遗症的发生.     

新生儿缺氧缺血性脑病的临床CT研究

目的探讨新生儿缺氧缺血性脑(HIE)CT损伤与临床缺氧程度的关系.方法对HIE 104例的CT变化严重程度分型与临床缺氧程度进行了对比性分析.结果 CT损伤轻度48例,中轻度缺氧44例(91.7%);CT重度24例中重度缺氧20例(83.3%).结论 HIE CT损伤分为轻、中、重三度,其与缺氧程度、预后关系密切.     

新生儿缺氧缺血性脑病的临床CT研究

目的　探讨新生儿缺氧缺血性脑 (HIE)CT损伤与临床缺氧程度的关系 .方法　对HIE 10 4例的CT变化严重程度分型与临床缺氧程度进行了对比性分析 .结果　CT损伤轻度 4 8例 ,中轻度缺氧 4 4例 (91.7% ) ;CT重度 2 4例中重度缺氧 2 0例 (83.3% ) .结论　HIECT损伤分为轻、中、重三度 ,其与缺氧程度、预后关系密切     

1、6二磷酸果糖治疗新生儿HIE病疗效观察及预后探讨

探讨1、6二磷酸果糖(FDP)治疗新生儿缺氧缺血性脑病(HIE)的疗效及预后.应用FDP治疗115例HIE患儿,剂量200-250mg/kg/日,半小时内缓慢滴注,每日1次,7天1疗程.轻者用1疗程,重者用2疗程.结果表明FDP能够缩短患儿的意识障碍时间,促进新生儿原始反射的恢复,与对照组相比差异显著P<0.05.通过对6个月-2岁小儿的随访,对照组后遗症发生率28%,治疗组后遗症发生率13.2%,明显低于对照组,差异显著(x2=4.71,P<0 05).结论外源性FDP能够显著的改善HIE患儿临床症状,改善预后,减少后遗症的发生.     

新生儿缺氧缺血性脑病脑电图及脑电地形图的特点和预后判定及45例临床分析

新生儿缺氧缺血性脑病 (HIE)是由各种原因所致围产期新生儿缺氧缺血所造成的常见中枢神经系统损害 ,窒息缺氧最终导致脑水肿、脑细胞的变性和坏死。HIE是新生儿死亡的重要原因之一 ,并可导致永久性的神经功能缺陷 ,如智力低下 ,癫痫和痉挛等。早期HIE的脑电图及脑电地形图的改变 ,可反映疾病时的脑功能障碍情况 ,并对HIE的早期诊断 ,治疗及预后判定有一定的作用。本文选择 4 5例HIE的脑电图及脑电地形图的改变进行分析 ,讨论了脑电图及脑电地形图的特点及预后判定。     

视频脑电图在新生儿缺氧缺血性脑病早期诊断及预后评估中的价值

目的:探讨视频脑电图(VEEG)对新生儿缺氧缺血性脑病(HIE)的早期诊断意义及预后的价值。方法:选择HIE患儿80例,在住院24 h内进行VEEG检查。异常者于14 d、42 d、3个月、6个月时复查,并随访1年,通过采集到的脑电及图像信号进行回放分析,并结合其他神经系统检查对预后进行评估。结果:80例确诊的新生儿HIE中,轻度HIE、中度HIE、重度HIE组VEEG异常发生率分别为38.8%、21.2%、20.0%;HIE重度组脑电图异常率为100%,中度组为88.5%,轻度组为65.7%(P0.05);且HIE重度组发生重度脑电图异常率68.8%(11/16例),中度组15.4%(4/26例),轻度组2.6%(1/38例)(P0.01);VEEG对HIE诊断阳性率80%高于MRI阳性率55%,差异有统计学意义。随诊80例患儿发生神经系统后遗症8例,死亡2例,脑电图多表现持续重度异常。结论:对HIE患儿在住院24 h内早期进行VEEG检查,有助于HIE的诊断及预后评估,且脑电图异常程度与HIE病情程度及预后情况基本成正相关,对脑电图持续重度异常的HIE患儿,发生脑损伤的机会非常高,应鼓励尽早在42 d内进行有效治疗,在3个月内尽早干预、进行康复治疗。     

番禺市新生儿缺氧缺血性脑病伴颅内出血118例临床分析

本文分析了我市１１８经临床及ＣＴ确诊的缺氧缺血性脑病伴颅内出血新生儿的的病因，临床表现，预后随访情况，认为在ＨＩＥ伴ＩＣＨ病儿中缺氧为主要发病因素，常有产伤因素并存。ＨＩＥ伴ＩＣＨ中以蛛网膜下腔出血最为多见。     

CT在新生儿缺血缺氧性脑病诊断中的价值意义

目的 探讨新生儿缺氧缺血性脑病(HIE)CT诊断价值和鍪别诊断及对预后的评估.方法 回顾性分析30例新生儿缺氧缺血性脑病的临床资料和CT表现并且进行分析讨论.结果 根据病情的程度不同表现为脑实质密度减低,灰白分界模糊,脑池脑沟变浅及颅内出血.CT对HIE敏感性高,是首选的影像学检查,其诊断对治疗和预后评估有很高的应用价值.结论 CT能对新生几缺血缺氧性脑病作出早期诊断和分度,能对颅内出血作出定性、定量诊断,对临床诊断治疗提供了很大的帮助,同时对判断病情的轻重及预后评估有重要价值.     

新生儿缺氧缺血性脑病与脑细胞凋亡及基因表达的关系

新生儿缺氧缺血性脑病(hypoxic-ischemicencephabpathy,HIE)是新生儿的常见疾病,本文主要对HIE中细胞凋亡及其相关基因的研究进展情况作一简述,旨在深入探讨HIE的发病机制,以便对HIE进行有效、及时的预防及治疗.     

小儿急性颅内出血98例临床分析

目的探讨小儿急性颅内出血的临床情况。方法对2004年1月至2006年12月收治的98例颅内出血临床资料进行回顾性分析。结果98例患儿中新生儿缺氧缺血性脑病(HIE)及颅内出血(ICH)32例,迟发性维生素K缺乏症30例,颅脑外伤12例,脑血管畸形12例,血小板减少症4例,血友病1例,出血性脑炎1例,急性白血病2例,脑肿瘤出血2例,原因不明2例。其中18例放弃治疗,15例死亡(病死率15.3%)。结论颅内出血预后较差,早期干预十分重要。     

Intracranial hemorrhage in adult patients with hematological malignancies

ABSTRACT: BACKGROUND: Clinical characteristics and outcomes of intracranial hemorrhage (ICH) among adult patients with various hematological malignancies are limited. METHODS: A total of 2,574 adult patients diagnosed with hematological malignancies admitted to a single university hospital were enrolled into this study between 2001 and 2010. The clinical characteristics, image reports and outcomes were retrospectively analyzed. RESULTS: A total of 72 patients (48 men and 24 women) with a median age of 56 (range 18 to 86) had an ICH. The overall ICH incidence was 2.8% among adult patients with hematological malignancies. The incidence of ICH was higher in acute myeloid leukemia (AML) patients than in patients with other hematological malignancies (6.3% vs 1.1%, P = 0.001). ICH was more common among patients with central nervous system (CNS) involvement of lymphoma than among patients with CNS involved acute leukemia (P <0.001). Sites of ICH occurrence included the cerebral cortex (60 patients, 83%), basal ganglia (13 patients, 18%), cerebellum (10 patients, 14%), and brainstem (5 patients, 7%). A total of 33 patients (46%) had multifocal hemorrhages. In all, 56 patients (77%) had intraparenchymal hemorrhage, 22 patients (31%) had subdural hemorrhage, 15 patients (21%) had subarachnoid hemorrhage (SAH), and 3 patients (4%) had epidural hemorrhage. A total of 22 patients had 2 or more types of ICH. In all, 46 (64%) patients died of ICH within 30 days of diagnosis, irrespective of the type of hematological malignancy. Multivariate analysis revealed three independent prognostic factors: prolonged prothrombin time (P = 0.008), SAH (P = 0.021), and multifocal cerebral hemorrhage (P = 0.026). CONCLUSIONS: The incidence of ICH in patients with AML is higher than patients with other hematological malignancies. But in those with intracranial malignant disease, patients with CNS involved lymphoma were more prone to ICH than patients with CNS involved acute leukemia. Mortality was similar regardless of the type of hematological malignancy. Neuroimaging studies of the location and type of ICH could assist with prognosis prediction for patients with hematological malignancies.     

早产儿缺氧缺血性脑病的CT表现及随访观察

目的探讨早产儿缺氧缺血性脑病（HIE）的CT特征及随访观察。方法回顾性分析经CT诊断的43例早产儿HIE,并与31例足月儿HIE的CT表现进行对照,着重探讨CT表现的特征。早产儿胎龄在28周至31周的13例,32周至38周的30例,男24例,女19例。对照组足月儿HIE31例,男14例,女17例。结果早产儿HIE脑内出血24例,其中室管膜下血肿11例,室管膜下血肿伴脑室内积血6例,室管膜下血肿伴脑室内呈铸形积血,并脑室扩张者7例,室管膜下血肿、脑室内积血伴有蛛网膜下腔出血3例。结论早产儿HIE损伤部位主要位于室管膜下区及脑室周围,后遗表现主要是脑室周围软化症和脑白质发育不良。     

新生儿缺血缺氧性脑病危险因素的logistic回归分析

目的分析新生儿缺血缺氧性脑病危险因素。方法采用回顾性研究方法,对202例新生儿缺血缺氧性脑病的相关因素进行logistic回归分析。结果危险因素按OR值排序,依次为5m in Apgar评分<4分、1m in Apgar评分<4分、宫内窘迫、新生儿肺透明膜病、颅内出血、产程延长。结论产科因素或围生因素是缺血缺氧性脑病发生的主要原因,加强围生期保健,提高产科技术,提高新生儿窒息复苏技术。对于降低新生儿缺血缺氧性脑病的发生率有重要意义。     

Long-term neuropsychological outcome of high risk infants with intracranial hemorrhage.

Evaluated long-term neuropsychological outcome of 20 high risk infants with intracranial hemorrhage (ICH) during the neonatal period who appeared free of significant impairment through 30 months of age. This group was compared with a matched sample of 20 high risk infants without intracranial hemorrhage and a group of 70 children with no history of perinatal or chronic health problems. A comprehensive neuropsychological evaluation at age 5 revealed that the two high risk groups tended to perform at a lower level than the control group across most measures. However, the ICH group performed at a significantly lower level than the control group on measures of perceptual-motor skills and intermodal memory abilities while the high risk group without ICH did not. The implications of differences in level and pattern of performance are discussed along with the implications of the current findings for long-term functioning of high risk infants with ICH.     

新生儿缺氧缺血性脑病的MR诊断及临床分析

目的探讨新生儿缺氧缺血性脑病的临床与磁共振成像诊断价值。方法50例临床诊断为缺氧缺血性脑病的患儿,对其进行MR的T1WI、T2WI、DWI及FLAIR序列检查,观察皮层及皮层下白质、深部白质、基底节及丘脑、脑室及脑外间隙等部位。结果缺氧缺血性脑病患儿MRI的T1WI及FLAIR序列病灶检出率明显高于T2WI(P<0.05),DWI序列可早期发现部分病变;缺氧缺血性脑病患儿早期Apgar评分与MRI脑白质损伤影像分级有一定相关性,但非绝对相关。结论MRI对缺氧缺血性脑病的诊断有高度的敏感性,运用不同的MR序列可提高缺氧缺血性脑病患儿的检出率;缺氧缺血性脑病患儿预后须从临床与MR表现综合判断。     

Distal anterior cerebral artery aneurysms: clinical features and surgical outcome

Aneurysms of the distal anterior cerebral artery (DACA) are rare and their surgical treatments present some unique difficulties from a technical standpoint. In this report, we presented our experiences of cases with DACA aneurysms, and analyzed the clinical features and prognostic factors affecting the final outcomes. Among 770 cases of intracranial aneurysms operated from 1990 to 1998, 19 cases of DACA aneurysms (2.5%) were studied retrospectively. The characteristic findings were female preponderance (M:F = 1:2.8), common multiple aneurysms (57.9%), and frequent intracerebral hemorrhage (ICH) on initial brain CT scan (42.1%). All patients were operated via interhemispheric approach. Intraoperative aneurysmal rupture was developed only in 3 cases (15.8%), and had no relationship with the final outcome Fifteen out of 19 patients (78.9%) showed favorable outcome with a mortality rate of 5.3%. The follow-up data suggest that the initial ICH on brain CT scan portend a poor prognosis.     

Management of intracranial hemorrhage in patients with mechanical circulatory support: a role for low-molecular-weight heparins?

Patients on mechanical circulatory support are at high risk of bleeding, particularly intracranial hemorrhage (ICH). The management of ICH in patients needing anticoagulation and antiplatelet therapies remains a challenge. We report our initial experience of ICH management with low-molecular-weight heparin in patients with mechanical circulatory support, without bleeding or thromboembolic complications.     

转肝细胞生长因子的脐带间质干细胞移植促进大鼠脑出血后髓鞘再生

目的： 研究转人肝细胞生长因子（hHGF）人脐带间质干细胞(hUCMSCs)移植对脑出血后脱髓鞘再生和神经功能恢复的影响。方法：SD大鼠60只,随机分为3组：脑出血＋hUCMSCs-HGF组、脑出血＋hUCMSCs 组和脑出血＋PBS组,每组20只。胶原酶诱导建立脑出血模型,据不同组别于术后7 d 立体定向下进行侧脑室相应的移植。分别于移植前1 d 和移植后1、7、14、21、28、35 d 利用mNSS (modified neurological severity scores)评分检测大鼠神经功能情况,应用劳克坚牢蓝检测脑损伤区的神经纤维恢复情况,利用免疫组化和Western blotting检测髓鞘碱性蛋白（MBP）的表达变化。结果：脑出血模型大鼠术后3周（即移植术后2周）mNSS评分检测的神经功能,hUCMSCs-HGF组和hUCMSCs组的神经功能改善较PBS组明显提高（P＜0.05）,而且hUCMSCs-HGF组较hUCMSCs组神经改善更加显著（P＜0.05）。hUCMSCs-HGF组的神经纤维修复较其它组明显改善,髓鞘碱性蛋白的表达较其它组亦明显提高（P＜0.01）。结论：转hHGF人脐带间质干细胞移植较单纯细胞移植能明显提高神经纤维髓鞘再生能力,促进脑出血后神经功能缺失的修复。     

血清铁调素及铁代谢指标与脑出血早期病情及预后的相关性研究

目的　探讨脑出血患者血清铁调素及铁代谢指标的变化与脑出血神经功能缺损严重程度及预后的相关性。 方法　选取本院脑出血首发患者92例为观察组,92例健康体检者为对照组,检测发病后1、3、5、7及14 d两组血清铁调素（serum hepcidin,Hep）、血清铁蛋白（serum ferritin,SF）和白细胞介素-6（interleukin-6,IL-6）含量。观察组患者入院第3 d采用美国国立卫生研究院卒中量表评估病情严重程度,分为轻型、中型、重型3组;发病3月时采用改良Rankins’量表评估神经功能恢复情况,分为预后好组、预后差组。观察组根据CT资料计算入院时与入院第3 d的相对水肿体积系数。比较观察组与对照组各时间点Hep、SF、IL-6水平。分析Hep、SF、IL-6水平与神经功能缺损程度及预后的关系。 结果　观察组各时间点血清Hep、SF、IL-6水平均高于对照组,差异具有统计学意义（P<0.05,P<0.01）;观察组轻、中、重型3组各时间点血清Hep、SF、IL-6水平两两比较,差异有统计学意义（P<0.01）;观察组预后好组、预后差组各时间点血清Hep、SF、IL-6水平两两比较,差异有统计学意义（P<0.01）。观察组血清Hep水平与SF、IL-6水平及入院后第3 d相对水肿体积系数呈正相关（P<0.01）。 结论　血清Hep、SF、IL-6水平与脑出血的发生、病情严重程度、预后有密切关系,可作为判断ICH病情严重程度及预后的评价指标。