B超引导下婴儿晚发性维生素K缺乏颅内血肿的外科治疗

目的 探讨婴儿晚发性维生素K缺乏所致颅内出血的诊断及外科治疗。方法 对31例婴儿晚发性维生素K缺乏症致颅内出血的患儿进行手术治疗．其中12例侧脑室穿刺外引流术应用了经前囟头颅B超立体定向引导技术。结果 治愈26例．好转3例，死亡2例。结论 对本病有手术指征患儿及时手术，可明显降低病死率及致残率。应用头颅B超立体定向引导技术，使侧脑室穿刺更准确。     

晚发型维生素K缺乏症致颅内出血20例治疗体会

晚发型维生素K缺乏症临床上多表现为皮肤瘀斑和消化道出血，合并颅内出血者病情危重，容易误诊，易遗留神经系统后遗症。现将我科自1993～2001年收治的晚发型维生素K缺乏症致颅内出血20例的治疗体会报告如下。     

婴儿晚发型维生素K缺乏致颅内出血32例临床分析

目的总结晚发型维生素K缺乏所致颅内出血的早期诊断和治疗经验。方法观察32例颅内出血患儿的临床特征,检测凝血时间,头部CT检查。结果32例均有不同程度颅内出血,经治疗30例好转治愈,仅2例留有后遗症。结论高度重视维生素K缺乏的存在,尽量减少漏诊、误诊的发生。     

婴儿晚发型维生素K缺乏致颅内出血32例临床分析

目的 总结晚发型维生素K缺乏所致颅内出血的早期诊断和治疗经验.方法 观察32例颅内出血患儿的临床特征,检测凝血时间,头部CT检查.结果 32例均有不同程度颅内出血,经治疗30例好转治愈,仅2例留有后遗症.结论 高度重视维生素K缺乏的存在,尽量减少漏诊、误诊的发生.     

晚发型维生素K缺乏症致颅内出血20例治疗体会

晚发型维生素K缺乏症临床上多表现为皮肤瘀斑和消化道出血,合并颅内出血者病情危重,容易误诊,易遗留神经系统后遗症。现将我科自1993—2001年收治的晚发型维生素K缺乏症致颅内出血20例的治疗体会报告如下。     

晚发型维生素K1缺乏症致颅内出血34例临床治疗体会

目的 总结晚发型维生素K1缺乏症致颅内出血临床治疗体会。方法 回顾性分析2012年1月至2015年10月收治的34例晚发型维生素K1缺乏症致颅内出血的临床资料。脑室周围-脑室内出血7例及单纯蛛网膜下腔出血3例,反复腰椎穿刺术脑脊液置换后病情好转。脑室周围-脑室内出血合并脑室扩大、梗阻性脑积水4例,紧急行储液囊脑室外引流术。硬膜下出血10例中,5例保守治疗;5例伴占位效应、中线结构偏移,急诊手术治疗。脑内血肿10例中,7例保守手术;3例血肿量较大,行开颅血肿清除术。结果 存活32例,放弃治疗2例;存活32例中,25例神经功能改善良好,7例改善差。治疗后随访3个月~1年,预后良好22例,预后中等7例,预后差3例。结论 晚发型维生素K1缺乏症致颅内出血往往病情危重,应早期诊断、及时治疗,对于不同出血类型采用个体化治疗方案,实施个体化的围手术期管理,可有效改善预后。     

晚发型维生素K缺乏症的防治

晚发型维生素K缺乏症是一种发生于生后2周到婴儿期由维生素K缺乏引起的出血性疾病。本病多发生在农村纯母乳喂养儿，常引起颅内出血，起病急，进展快，致残率和病死率高。对本病认识不足，易致误诊，应引起基层医务人员的重视。本文回顾分析我院1995-07～2002-06收治的152例晚发型维生素K缺乏症，并对本病的防治进行探讨。     

维生素K依赖因子缺乏致颅内血肿的神经外科治疗

目的进一步探讨新生儿颅内出血外科的治疗和手术方法的选择及其治疗效果。方法对18例维生素K依赖因子缺乏颅内出血患儿临床资料进行回顾性分析。结果1例死亡外所有患儿在儿科诊断和治疗基础上施行微创手术,清除颅内血肿疗效显著,均治愈出院。结论微创手术清除婴儿颅内出血可减轻神经系统后遗症,降低婴儿期颅内出血的病死率。     

维生素K依赖因子缺乏致颅内血肿的神经外科治疗

目的 进一步探讨新生儿颅内出血外科的治疗和手术方法的选择及其治疗效果.方法 对18例维生素K依赖因子缺乏颅内出血患儿临床资料进行回顾性分析.结果 除1例死亡外,所有患儿在儿科诊断和治疗基础上施行微创手术,清除颅内血肿疗效显著,均治愈出院.结论 微创手术清除婴儿颅内出血可减轻神经系统后遗症,降低婴儿期颅内出血的病死率.     

婴儿维生素K缺乏症合并颅内出血的外科手术治疗

我院自2004 年7 月-2008 年6 月诊断、治疗维生素K 缺乏症合并颅内出血患儿28例,现将结果报告如下. 临床资料 一、一般资料 28 例患者,男17 例,女11 例;年龄为4 周～ 6 个月,平均39 d,均为母乳喂养,出生后未补充维生素K,符合晚发性维生素K 缺乏症合并颅内出血诊断标准[1,2].     

婴儿晚发型维生素K缺乏症颅脑CT表现

目的探讨婴儿晚发型维生素K缺乏症颅脑CT表现特征,提高定性诊断水平。方法本文回顾性分析35例维生素K缺乏症颅脑CT表现,并对临床表现和CT所见进行整理分析。结果 (1)以硬膜下血肿和蛛网膜下腔出血较多,而脑实质和脑室出血较少,多部位出血占68.6％,硬膜下血肿多累及枕部,内缘不光滑;(2)一侧或两侧大脑半球明显水肿(71.4％)而基底节正常;(3)多部位出血,明显脑水肿和伴有脑疝者预后不良。结论作者认为累及枕部的硬膜下血肿和蛛网膜下腔出血伴大脑半球广泛水肿,而基底节正常的CT表现是本病颅内出血特征性表现,有一定的定性诊断价值。     

Intracranial hemorrhage in infancy due to vitamin K deficiency: report of a case with multiple intracerebral hematomas with ring-like high density figures

It is well known that vitamin K deficiency is an important cause of the spontaneous intracranial hemorrhage in infancy. A 60-day-old male infant with spontaneous intracerebral hematomas due to vitamin K deficiency was presented. He was breast-fed. He had been medicated oral antibiotic agent for diarrhea and fever. Three days later he developed petechien, vomiting and twitching, and became drowsy. The blood studies showed anemia, and advance of ESR. He was administered of vitamin K immediately. CT scan was showed four intracerebral hematomas with niveau, which were surrounded by high-density rings. The ring-like figures were unique for this case. The reason may be next, we think. Under the states in which blood can separate easily with advance of ESR, blood clot would adhere to the wall of the hematomas. So these hematomas showed ring-like figures and had niveau in them. CT scan of this case was also interesting because there was little deviation in spite of the big hematomas. The reason of this may be that the brain of infancy is incomplete in myelination and contains much water, and that the possibility of bleeding due to vitamin K occurs slowly. We examined 84 cases of intracranial hemorrhage due to vitamin K deficiency from literatures, and they were all identified for the hemorrhage sites by CT scan. Subarachnoidal hemorrhage was in 72 cases (85.7%), subdural hemorrhage was in 41 cases (48.8%), intracerebral hematomas was in 36 cases (42.9%) and intraventricular hemorrhage was in 9 cases (10.7%). In 52 cases the CT findings were described.(ABSTRACT TRUNCATED AT 250 WORDS)     

妊娠高血压综合征合并脑出血的临床治疗

目的 探讨妊娠高血压综合征（妊高征）合并脑出血的临床治疗。方法 回顾研究我院收治的11例妊高征合并脑出血患者的治疗及预后。结果 9例患者行开颅血肿清除术,其中3例同时行剖宫产术,2例非手术治疗,患者肢体功能障碍均不同程度好转。结论 对妊高征合并脑出血患者选择适宜的治疗方案,可降低母婴死亡率和致残率。     

婴儿晚发型维生素K缺乏致颅内出血28例诊治体验

目的　总结婴儿晚发型维生素K缺乏所致颅内出血的诊治体验。方法　对近 10年收治的 2 8例患儿的临床特点、诊断及治疗进行回顾分析。结果　本组保守治疗 15例 ,手术 13例 ,共治愈 2 1例 ,死亡 7例 ,随访 1～ 8年 ,13例发育正常 ,8例遗有不同程度神经系统后遗症。结论　掌握其临床特点并作出早期诊断 ,根据具体病情选择合适的治疗方法是降低本病病死率及致残率的关键。     

Cerebral hemorrhage as the initial manifestation of cystic fibrosis

The authors present a case of an infant boy, otherwise healthy, who presented with acute irritability and obtundation. A head computed tomography scan revealed massive intracerebral hemorrhage. Investigations of the etiology revealed abnormal clotting times and reduced activity of all vitamin K-dependent factors. All etiologies of vitamin K deficiency were ruled out except malabsorption. The diagnosis of cystic fibrosis was confirmed by sweat chloride and genetic testing. Cystic fibrosis could present with cerebral bleed and should be considered in its differential diagnosis when other etiologies are not clear, as the other manifestations of vitamin K deficiency could be very subtle and unnoticed. Screening and early diagnosis of cystic fibrosis may prevent serious complications.     

尿激酶动脉内溶栓联合血管内干预治疗急性脑梗死分析

目的分析尿激酶动脉内溶栓联合血管内干预治疗急性脑梗死的疗效和安全性。方法回顾分析我科住院治疗13例患者进行尿激酶动脉内溶栓及血管内干预治疗的急性脑梗死患者临床资料。结果 13例患者中,颈动脉系统病变11例,其中颈内动脉闭塞2例,大脑中动脉主干及分支闭塞8例,大脑前动脉闭塞1例(包含脑血管造影未见异常者3例),椎基底动脉闭塞2例。溶栓开始时间3～12h,平均7.5h,其中10例在6h内开始。使用尿激酶30万～100万U,平均70万U。溶栓后2例给予血管内支架治疗,4例给予球囊扩张血管成形治疗。基本痊愈5例,显著进步5例,无效3例。闭塞血管成功再通7例,未成功再通3例。并发脑出血1例,死亡1例,无并发消化道出血等其他情况。结论对急性脑梗死患者进行尿激酶动脉内溶栓联合血管内干预治疗是安全有效的。     

36例长期口服阿司匹林脑出血患者的手术及相关处理

目的 探讨中老年人长期口服阿司匹林合并脑出血的诊断与相关治疗.方法 36例长期口服阿司匹林日剂量100 mg或以上的中老年人,头颅CT检查脑出血多于30 ml,12例急诊手术清除血肿;24例保守治疗后病情加重,手术清除血肿4例,立体定向血肿腔置管外引流9例,11例非手术治疗.结果 3个月评估,手术组10例基本生活自理,9例无自主生活能力,6例死亡;未手术组5例基本生活自理,4例无自主生活能力,2例死亡.结论 长期服用阿司匹林并发脑出血患者,应停服阿司匹林,给予促凝药物、新鲜血浆或血小板治疗,病情危重应手术治疗,轻者尽可能非手术治疗.

Abstract：

Objective To study the diagnosis and treatment strategy in middle - aged and old patients of cerebral hemorrhage used long - term aspirin. Method We retrospectively studied 36 middleaged and old patients of cerebral hemorrhage used aspirin with or over the doses of 100 mg/d, and the hemorrhage exceeded over 30 ml revealed by CT scan. After accurate evaluation, 12 patients were treated with craniotomy for evacuation of hematoma. Among the 24 patients treated with expectant treatment, 4 patients were treated with evacuation of hematoma due to aggravation of the general condition, 9 were treated with external drainage of the hematoma, 11 were treated with expectant treatment. Results Evaluation three months later showed that 10 patients in operation group recorvered with the ability of self - care and 9 patients did not, 6 patients died. In the expectant treatment group, 5 patients had the ability of self - care and 4 patients had not, 2 patients died. Conclusions Patients with long - term aspirin treatment must stop having it when complicating with cerebral hemorrhage. Setting accelerator, fresh plasma and platelet could be used. Operations may be essential for patients with serious conditions, and no - operative therapy for others with stable conditions.