新生儿惊厥59例病因分析

目的探讨新生儿惊厥的病因及急救方法，减少新生儿惊厥及后遗症的发生。方法回顾分析我院近两年间收治的59例新生儿惊厥的临床特点、实验室检查结果、治疗及转归情况，探讨其常见的病因及治疗方法。结果痊愈出院44例，好转后出院8例，放弃治疗5例，死亡2例。新生儿缺氧缺血性脑病仍是导致新生儿惊厥最主要的病因，感染是新生儿期惊厥的第二大原因。治疗重点在于止痉，药物首选苯巴比妥，根本在于病因治疗。结论缺氧缺血性脑病、感染、低血糖和低血钙是导致新生儿惊厥的主要病因，苯巴比妥仍是首选的抗惊厥药物。     

新生儿惊厥50例临床分析及治疗

目的探讨新生儿惊厥的病脚、临床表现的特点和急救措施。方法对我院50例新生儿惊厥患儿的临床资料和急救措施的有效性进行分析总结。结果新生儿惊厥的病因顺位依次是新生儿缺氧缺血性脑病23例、颅内出血10例、新生儿化脓性脑膜炎8例，此3种病因占全部病例的82％。惊厥发作类型以轻微型为主。结论减少新生儿惊厥的关键是做好围产期保健，积极防止新生儿缺氧缺血性脑病的发生；新生儿轻微型惊厥在临床上不易被发现，需密切观察，及时诊治；止痉药首选苯巴比妥钠静脉推注。     

视频脑电图监测在新生儿惊厥发作中的作用分析

目的 探讨视频脑电图(video electroencephalogram,VEEG)监测在新生儿惊厥发作中的诊断作用.方法 选择2012年1月至2016年7月延安市人民医院NICU收治的窒息及疑似惊厥发作的新生儿85例作为研究对象,应用 VEEG 监测其脑电活动及新生儿各种临床行为,并对监测的VEEG结果和患儿的临床发作事件进行分析.结果 85例窒息及疑似惊厥发作的新生儿中,28例(32.9%)确诊为新生儿惊厥,其中24例有明确病因,分别为新生儿缺氧缺血性脑损伤14例,中枢神经系统感染4例,低血糖3例,电解质紊乱3例,4例病因不明.28例惊厥患儿中,20例经治疗后随访时间1~12个月,且于出院后经复查VEEG均未监测到临床惊厥发作及脑电图异常放电,其中16例患儿精神、运动发育良好,4例患儿有不同程度的脑损伤,1例患儿近期出院,随访时间短,失访3例.4例放弃治疗,随访中3例已死亡.结论 新生儿惊厥发作常不典型,多为亚临床及微小发作,临床上难以鉴别,容易漏诊及误诊.VEEG监测在新生儿惊厥发作的诊断中具有敏感、准确及无创等优点,有利于早期治疗和改善预后,是目前临床上诊断新生儿惊厥的金标准.     

新生儿惊厥161例临床分析

目的 总结新生儿惊厥的发生率、病因及临床特点.方法 回顾性分析161例惊厥新生儿临床资料.结果 惊厥发生率12.4%;男女之比为2.2:1;惊厥首发时间为生后51.6 h,13.0%的患儿足量苯巴比妥不能控制.治疗后85.7%治愈出院,10.6%有症状出院,3.1%死亡,1.16%自动出院.围产期窒息(47.2%)是引起惊厥的首要病因,其次是糖及电解质紊乱(13.0%)、感染性疾病(16.2%)、各类遗传代谢病(6.8%).发作类型以微小性发作为主(26.7%),其次为阵挛性发作(23.0%).结论 (1)窒息是导致新生儿惊厥发生的主要原因.(2)发作形式以微小性发作最多见.(3)苯巴比妥仍是抗新生儿惊厥的一线药,少数患儿应用该药后惊厥不能控制,制定一套安全有效的抗新生儿惊厥治疗方案迫在眉睫.     

新生儿惊厥

惊厥是新生儿中枢神经系统功能异常最常见的临床表现.由于新生儿脑发育的阶段性,惊厥多见于新生儿,其表现和对药物治疗的反应有其自身特点.惊厥可使脑损伤加重,甚至留下神经系统后遗症.因此,新生儿期的惊厥应及时的诊断和处理.该文主要介绍新生儿惊厥的病因和病理生理、临床表现、治疗和预后几个方面的选展.     

新生儿惊厥病因分析

新生儿惊厥是新生儿疾病常见的症状,病因复杂病死率高.我院新生儿病区2000年9月～2002年9月共收住新生儿1255例,其中发生惊厥者138例,现将该组病例的病因及临床表现特点分析如下.     

神经系统及精神疾病

072738新生儿惊厥51例病因分析/张∥蚌埠医学院学报.-2007,32(2).-202～203回顾分析51例新生儿惊厥的病因,从原发病、发病日龄、惊厥发作类型,分别探讨与病因的关系。结果:缺氧缺血性脑病(HIE)和颅内出血(ICH)多在生后3d内发病,低血钙和感染多在生后7d发病。51例中痊愈32例,好转7例,病死6例,各种原因放弃治疗6例。参5(原文摘要)072739新生儿惊厥176例临床分析/蒋英…∥实用全科医学.-2007,5(6).-483～484对176例新生儿惊厥患儿的临床资料进行回顾性分析。结果:显示以缺氧缺血性脑病和颅内出血多见,发病时间多在生后3d内;其次为低血钙和低…     

新生儿惊厥发作形式与病因及预后的相关性

目的 加强对新生儿惊厥发作形式的认识,分析其病因及其预后,为早期诊断和治疗提供依据.方法 对近4 a本院新生儿病房收治的302例患儿作全面观察并列表记录,尤其注意新生儿呼吸节律的突然变化、局部怪异动作、肢体抽动等情况,对可疑者予以重点观察,确定惊厥形式,并行血常规、血钙、血糖及脑CT检查,部分患儿行脑电图、血培养检查.在患儿出院后(52±2)周行书面随访,对有问题者进一步在专科、门诊进行检查随访,包括脑电图、脑CT、盖泽尔发育检查及神经系统体检.结果 发生惊厥新生儿52例,可分为5种发作类型,分别为轻微型28例、多灶性阵挛型8例、面肌阵挛型7例、局灶性阵挛型6例及全身性阵挛型 3例.其惊厥原因有HIE 18例,颅内出血12例,低血钙6例,低血糖、败血症各4例,颅内感染2例,核黄疸、破伤风各1例,病因不明 4例.后遗症发生率为18.18%,其中以智力低下(MR)占首位(9.89%).结论 新生儿惊厥病因复杂,发作类型多样,轻微型最多见,对阵发性呼吸节律紊乱、下颌抖动及面部怪异动作的新生儿应提高警惕,及早识别.后遗症与发作形式及病因相关密切.     

早产儿惊厥相关临床问题

随着围生期医学、新生儿急救医学和康复医学的发展,采用综合的治疗措施和康复训练在一定程度上改善了早产儿惊厥的预后。但是,由于早产儿惊厥病因复杂,缺少特异性临床表现,容易漏诊或误诊,而且临床多采用对症支持治疗,预后较差,死亡率近38%,幸存者中约80%可能出现运动功能障碍、弱智、脑瘫和癫疒间等[1]。因此,国内外新生儿学专家呼吁重视早产儿惊厥的研究[2]。本文将讨论目前早产儿惊厥面临的几个重要临床问题。     

新生儿惊厥 2 例临床及基因分析

目的探讨新生儿惊厥的诊断及治疗。方法回顾分析2例新生儿惊厥病例的临床资料。结果 2例患儿均为男性,1例为早产儿,均于生后第2天发生惊厥。入院后经各项检查除外常见惊厥原因后行基因检测。例1为SCN2A基因突变(c.5558AG,p.H1853R),给予苯巴比妥止惊,后加用托吡酯,无明显好转;例2为KCNQ2基因突变(c.836GA,p.G 279 D),为新发突变,口服苯巴比妥,生后21天加用左乙拉西坦并逐渐加量,第36天加用托吡酯并逐渐加量,下肢肌张力仍稍高。结论新生儿惊厥病因复杂,基因检测可明确病因,并可为治疗及预后评估提供参考。     

儿童动脉缺血性卒中的病因

目的总结儿童动脉缺血性卒中(AIS)的临床特点、病因及危险因素。方法回顾性分析2003年1月-2011年3月在重庆医科大学附属儿童医院住院治疗的AIS患儿资料,采用SPSS 17.0软件进行分析,描述患儿年龄、性别分布等基本情况、相关病因及危险因素,并分析头部轻微外伤与基底核钙化是否存在相关性。结果本组患儿中,男31例,女27例;年龄2个月～13岁,平均3岁10个月。常见神经系统表现依次为肢体偏瘫52例(92.8%),中枢性面瘫34例(58.6%),运动性失语16例(27.6%),头痛、呕吐11例(19.0%),意识障碍8例(13.8%),惊厥7例(12.1%)。40例进行血管影像学检查,其中33例异常,左侧大脑中动脉受累最常见(19例,47.5%)。常见病因为轻微头部外伤(26例,44.8%)、烟雾病(8例,13.8%)和颅内感染(5例,8.6%),18例(31.0%)患儿为多病因共存,6例(10.3%)患儿未找到任何病因或危险因素,22例(37.9%)患儿有呼吸道感染。结论儿童AIS发病高峰人群为幼儿及学龄前期儿童,最常见的神经功能障碍为肢体偏瘫,神经影像学显示左侧大脑中动脉狭窄或中断最常见,常见病因为轻微头部外伤、烟雾病及颅内感染,较多患儿病前或病程中有上呼吸道感染。积极预防感染、减少头部外伤,对突发偏瘫患儿早期行头颅影像和血管检查将有利于AIS的预防和早期诊断。     

Febrile convulsion--a clinical survey and a review of its current concept of management

Between February 1986 to November 1986, 335 cases of febrile convulsion were admitted to the paediatric ward, Tan Tock Seng Hospital. The study revealed 87 cases (26%) were complex febrile convulsion and 73 cases (21.8%) were recurrent febrile convulsion. 51 patients with complex febrile convulsion and 32 patients with recurrent febrile seizures were put on long term phenobarbitone. The number of patients with recurrent and complex convulsion was big. The role of anticonvulsant prophylaxis is reviewed and its efficacy discussed.     

Genetic and Diagnostic Studies of Mental Retardation

The etiologies of 866 patients with mental retardation who visited the outpatient clinic were studied, being classified by the period when the causes were estimated to have occurred. The results revealed that a majority, 657 patients (75.9%), were in the prenatal group. Among the patients who belonged to the prenatal group, 260 patients (30%) exhibited chromosomal aberrations. Chromosomal aberrations were sporadically noted in 248 patients (96.9%), and the number of patients originating from balanced translocation of either parent was 8 (3.1%). Hereditary diseases were recognized in 53 patients (6.1%), among whom 2 patients with fragile X-linked mental retardation were detected. The number of patients who belonged to the perinatal and postnatal groups was markedly few.     

昆明市儿童院前急救486例临床分析

目的 研究2008年昆明市儿童院前急救流行病学特点.方法 采用回顾性调查分析的方法,对2008年我院院前急救病例的疾病谱、来源现场、就诊高峰等进行统计分析.结果 2008年昆明市儿童院前急救中有完整资料者486例,男女比例为1.47:1;以13个月～3岁最多(39.30%),其次为29d～12个月(29.84%);疾病分布占前5位的依次为:高热惊厥(30.45%)、消化系统疾病(14.19%)、呼吸系统疾病(13.37%)、无热抽搐(11.93%)、发热(10.08%).现场地点以家庭为主要来源(37.86%);其次为乡镇卫生院及企事业卫生服务站(21.81%);来源于公共场所最少(7.61%).院前急救以5、6月份和9、10、12月份为两个高峰,以2、3月份为低谷;每日中13:00、19:00和23:00为3个就诊高峰,3:00-9:00为最低谷;高热惊厥以冬季发病率高,呼吸系统和消化系统疾病院前急救以夏、秋季为高发.结论 对儿童院前急救医务工作者的培训应以高热惊厥、消化系统及呼吸系统疾病作为重点,同时应以家庭为单位普及高热惊厥等急症的健康教育,加强基层医疗投入,合理安排急救资源.     

Acute diarrhea in Baltimore children attending an outpatient clinic

Acute diarrheal illnesses in Baltimore children younger than 2 years of age attending an outpatient clinic were studied during a 12-month period. One in five acute care visits made to the clinic by children younger than 2 years was for diarrhea, and 5% of diarrhea cases required hospitalization. With the use of comprehensive methodology, a potential etiologic agent was identified in the stool of 105 (43%) of the 246 episodes of diarrhea in cases and in 43 (28%) of the 155 controls. Viral pathogens were found in 26% of episodes, and bacterial pathogens were found in 14%. Only rotavirus, enteric adenovirus and Salmonella were significantly associated with diarrhea. Cases were more likely to have measures of socioeconomic deprivation, such as household crowding, low maternal educational level and low birth weight, when compared to controls. Racial differences in morbidity from diarrheal illnesses were observed but could be attributed to these specific sociodemographic factors. Despite the low mortality caused by infantile gastroenteritis in the United States, it remains an important public health problem. However, even with intensive investigation the etiologies remain largely unknown.     

热性惊厥复发危险因素与预后分析

目的研究热性惊厥患儿的复发危险因素及预后情况.方法结合98例热性惊厥患儿的临床及脑电图资料,研究其复发、转为癫和出现智力障碍及行为异常的情况.结果复发共52例(53.0%),复发危险因素与惊厥家族史、初次发作体温＜38.5℃、初次发作年龄＜1岁及复杂型热性惊厥有关(P＜0.01);热性惊厥转为癫共20例(20.4%),转为癫的危险因素与复杂型热性惊厥、初次发作年龄＜1岁、热性惊厥反复发作有关(P＜0.01);发生智力障碍及行为异常2例(2.0%),说明热性惊厥患儿绝大部分预后较好,智力低下及行为障碍发生率低.结论对有复发危险因素及转为癫危险因素的患儿,应密切随访,采取适当的干预措施.     

Severe neonatal thrombopenia. Analysis of the etiologic data on 64 cases

In many cases of neonatal thrombocytopenia, etiology does not fit with usually known causes. Analyzing, in an intensive care unit, 64 cases of severe neonatal thrombocytopenia (platelets less than 50 x 10(9)/l before hour 72), the authors attempted to determine other possible causes of the disorder. In this study, classical etiologies were present in 33% of cases. In the other 67%, hypotrophy and/or hypoxia were significantly more frequent (p less than 0.01) than in the first group. With reference to clinical and experimental data in the literature, the possible role of acute or chronic hypoxia as a cause of thrombocytopenia is discussed.     

Etiology of failure to thrive in infants and toddlers referred to a pediatric endocrinology outpatient clinic

The aim of this study is to determine the underlying etiology of failure to thrive (FTT) in infants and toddlers referred to an outpatient pediatric endocrinology clinic. A chart review was done on FTT referrals to a pediatric endocrinology outpatient clinic between 2002 and 2005. Majority of patients (51.5%) had a purely nutritional deficiency. The endocrine etiologies included short stature due to being small for gestational age, constitutional or familial short stature (28.9%). The third most common etiology was gastrointestinal disease. Endocrine causes of FTT seem to be rare even in the selected population of patients referred to pediatric endocrine outpatient clinics. In the primary care setting, nutritional assessment and consultation seem to be adequate in the majority of cases. Only a small percentage of the patients with FTT will require a multidisciplinary approach and more extensive work-up.     

儿童致死性病毒性脑病7例

目的探讨致死性病毒性脑病的临床和实验检查特点。方法回顾性分析7例致死性病毒性脑病患儿临床过程及预后,肝酶学、脑脊液常规改变,头颅CT改变。结果7例患儿均呈骤然高热、严重抽搐和迅速进入昏迷、肝酶显著升高。4例死亡,3例留有严重神经系统后遗症;血氨均正常;头颅CT均显示显著脑肿胀,可见对称性基底核低密度病变。结论高热、迅速发生抽搐和昏迷、肝功能损害的患儿,应警惕致死性病毒性脑病发生。     

Chronic hoarseness in children. Evaluation based on personal series of 64 cases]

Chronic hoarseness is frequent among children, as shown by 64 cases observed over an 18-month period in a specialized phoniatric outpatients clinic. Age at the first consultation for these 64 patients was 3-14 year although the hoarseness was already known for more than 1 year in 40 patients (62.5%). The main findings at laryngoscopy were an edematous vocal cord (33%), a unilateral or bilateral nodular lesion (26%), and an epidermo?d cyst (17%). The larynx was normal in 2 patients only. Orthophonic re-education was prescribed for 45 patients (70%); it was followed by laryngeal microsurgery in 3 patients: 9 patients were completely cured, 26 were improved, 4 showed no improvement, 16 could not be located for follow-up. Chronic hoarseness in children has numerous etiologies which can be divided into 5 main groups. The 2 more frequent are the hyperkinetic or hypokinetic laryngeal dysfunctions and the congenital lesions. The 3 other groups are much less frequent: juvenile laryngeal papillomatosis, recurrent palsy and pithiatic aphonia. Laryngoscopy is important for the diagnosis. Orthophonic re-education represents the main treatment; it completes the surgical treatment when microsurgery of the larynx is necessary.