早产儿颅内出血继发梗阻性脑积水相关因素分析

目的探讨早产儿颅内出血后继发梗阻性脑积水的相关因素。方法将2013年6月至2014年9月住院,头颅超声示严重颅内出血(Ⅲ级及Ⅳ级)的早产儿304例,按是否继发脑积水分为脑积水组(59例)和非脑积水组(185例),分析颅内出血后继发梗阻性脑积水的相关影响因素,比较两组患儿在生后不同时间点的侧脑室增宽程度。结果单因素分析结果显示,胎龄≤32周、出生体质量1 500g、重度窒息、剖宫产、呼吸窒息综合征(RDS)、新生儿感染、心力衰竭、动脉导管未闭(PDA)、p H值≤7.2、血小板减少、凝血功能异常、Ⅲ或Ⅳ级颅内出血的比例,在脑积水与非脑积水两组之间的差异均有统计学意义(P0.05)。多因素logistic回归分析显示,p H值≤7.2、血小板减少、凝血功能异常、胎龄≤32周、重度窒息、Ⅲ或Ⅳ级颅内出血为继发梗阻性脑积水的独立危险因素(OR:1.76~20.46,P0.05)。出生后各时间点,脑积水组侧脑室的后角比值均大于非脑积水组,差异有统计学意义(P均0.05);脑积水组左侧和右侧脑室的后角比值随时间变化的差异均有统计学意义(P均=0.000),均在第14天时逐渐增大,第28天达到高峰。结论重视颅内出血后继发梗阻性脑积水的高危因素,对严重颅内出血患儿定期行头颅超声动态监测脑室增宽情况。     

早产儿颅内出血的预防及早期诊断：———附32例报告

早产儿颅内出血是新生儿早期死亡的重要原因之一,其发病率及病死率均较高。本文就我科经头颅ＣＴ证实为早产儿颅内出血的３２例报告如下。资料与结果自１９９３年８月至１９９７年６月我科收治早产儿１６０例,其中３２例经临床诊断及头颅ＣＴ证实为颅内出血,发生率２０％。其中男２２例,女１０例;胎龄≤３２周２２例,３３周５例,３４周３例,３５周２例;出生体重≤１５００ｇ１８例,１５０１～２２００ｇ１４例;顺产２５例,臀位产５例,剖宫产２例;～２４小时入院１８例,～４８小时入院８例,～７２小时入院４例,７２小时以上…     

早产儿颅内出血62例分析

1982年3月～1990年12月,我院174例新生儿尸检中早产儿93例,其中62例为颅内出血。蛛网膜下腔出血占100％,脑室内出血占48.4％,小脑幕出血占19.4％。本文报道共临床与病理,并提出头颅B超检查可提高早期诊断率,临床应用价值大。     

早产儿脑血流及与颅内出血的关系

目的了解早产儿脑血流（CBF）特点、影响因素及与颅内出血（PVH．IVH）的关系，探讨预测、预防早产儿颅内出血的有效方法。方法使用Logic 400超声诊断仪对胎龄28～35周早产儿分别于生后24h内、1、2、3、5、7d检查脑血流及颅内出血情况。结果大脑中动脉（MCA）脑血流参数显著高于大脑前动脉（ACA）及基底动脉（BA）。早产儿脑血流速度（CBFVs）随胎龄、日龄增加而增加，搏动指数（PI）与阻力指数（RI）无明显变化。随着平均动脉压增加，舒张期末最高血流速度（Vmin）增加，RI下降。早产儿颅内出血发生、发展与脑血流参数间无显著关系，出生24h后频谱形态异常改变提示颅内出血发生或发展。机械通气可导致早产儿脑血流频谱改变，从而使颅内出血发生或加重。结论早产儿MCA脑血流参数显著高于ACA及BA，常规监测早产儿脑血流参数不能预测颅内出血，但出生24h后频谱变化．有一定预测价值。     

早产儿颅内出血危险因素的meta分析

目的综合评价早产儿颅内出血的危险因素。方法检索Cochrane图书馆、PubMed、ScienceDirect、中国学术文献总库、万方数据库及学位论文数据库,并辅以文献追溯、手工检索等,收集2000年1月至2012年12月有关早产儿颅内出血危险因素的临床资料。对纳入的研究数据采用Cochrane协作网提供的Revman5.2进行统计分析,根据文献异质性检验结果选用固定效应模型或者随机效应模型进行meta分析。结果经过筛选,共纳入文献9篇,meta分析显示各危险因素的合并OR值及其95%CI分别为：胎龄≤32周（OR=3.29,95%CI=2.76~3.91)、出生体质量≤1500 g（OR=2.68,95%CI=2.24~3.20)、孕母有合并症（OR=1.59,95%CI=1.23~2.06）、有宫内窘迫或出生后窒息（OR=2.42,95%CI=2.06~2.84）、机械通气（OR=3.23,95%CI=2.55~4.09）、代谢性酸中毒（OR=2.88,95%CI=2.04~4.05）、使用高浓度氧（OR=2.98,95%CI=1.63~5.44）、产前使用地塞米松（OR=0.69,95%CI=0.55~0.86）、新生儿呼吸窘迫综合征（OR=1.57,95%CI=1.04~2.39）,差异均有统计学意义。剖宫产（OR=0.99,95%CI=0.84~1.17）、多胎（OR=1.05,95%CI=0.79~1.40）、性别（OR=1.25,95%CI=0.97~1.59）差异无统计学意义。结论早产儿颅内出血的主要危险因素为胎龄≤32周、出生体质量≤1500 g、孕母有合并症、有宫内窘迫或出生后窒息、机械通气、代谢性酸中毒、使用高浓度氧及新生儿呼吸窘迫综合征。产前使用地塞米松可降低早产儿颅内出血发生率。     

晚期早产儿颅内出血相关因素分析

颅内出血是导致早产儿死亡和残疾的主要原因,给家庭和社会带来沉重的经济和精神负担。长期以来,小胎龄早产儿的颅内出血防治问题一直备受关注,而占早产儿近74%的较大胎龄的晚期早产儿的颅内出血防治问题并未受到相应的关注。事实上,晚     

早产儿脑血流及与颅内出血的关系

目的了解早产儿脑血流(CBF)特点、影响因素及与颅内出血(PVH-IVH)的关系,探讨预测、预防早产儿颅内出血的有效方法.方法使用Logic 400超声诊断仪对胎龄28～35周早产儿分别于生后24h内、1、2、3、5、d检查脑血流及颅内出血情况.结果大脑中动脉(MCA)脑血流参数显著高于大脑前动脉(ACA)及基底动脉(BA).早产儿脑血流速度(CBFVs)随胎龄、日龄增加而增加,搏动指数(PI)与阻力指数(RI)无明显变化.随着平均动脉压增加,舒张期末最高血流速度(Vmin)增加,RI下降.早产儿颅内出血发生、发展与脑血流参数间无显著关系,出生24 h后频谱形态异常改变提示颅内出血发生或发展.机械通气可导致早产儿脑血流频谱改变,从而使颅内出血发生或加重.结论早产儿MCA脑血流参数显著高于ACA及BA,常规监测早产儿脑血流参数不能预测颅内出血,但出生24 h后频谱变化,有一定预测价值.     

早产儿脑血流的影响因素及临床意义

颅内出血是早产儿常见并发症,也是早产儿智力障碍及脑瘫的主要原因之一。颅内出血与脑血流(cerebral blood flow,CBF)关系密切。当脑血流波动超出其自动调节范围时,可导致脑室管膜下生发层基质毛细血管破裂,造成颅内出血。早产儿脑血流自动调     

Early prognosis of intracranial hemorrhage in premature infants

Between July 1979 and June 1984 an intracerebral haemorrhage developed in 87 premature infants (mean gestational age 29.5 weeks, mean birth weight 1156g). 46 of these died, 41 infants survived. Their psychomotoric development was followed up to a mean age of 19 months. In 63% of the patients the haemorrhage occurred during the first four days of life. Its frequency was highest in premature infants of 27 to 30 weeks of gestation. The survival rate was influenced by the gestational age and by the grade of haemorrhage. Early complications such as ventricular dilatation, hydrocephalus occlusus and porencephaly were seen especially in very immature infants (less than 31 weeks). The frequency of abnormal psychomotoric development in 55% of these infants contrasts with 13.5% in premature infants (less than 1 500 g) without intracerebral haemorrhage.     

Perinatal factors associated with early-onset intracranial hemorrhage in premature infants. A prospective study

Serial ultrasound examinations were performed on 40 consecutive newborn infants less than 35 weeks' gestational age. Fifteen of 17 infants with intracranial hemorrhage (ICH) had evidence of hemorrhage on the first ultrasound examination (mean age, 1.9 +/- 0.2 hours post partum). Comparing the clinical course of these 15 infants with age- and weight-matched non-hemorrhage controls showed a significant association between the occurrence of early ICH and the pattern of labor. There was no correlation between ICH and the mode of delivery, the use of sodium bicarbonate, volume administration, or the initial BP. In nine of the 15 infants with early-onset ICH, the hemorrhage progressed in severity during the first three postpartum days in association with increasing ventilatory requirements. The results of this study suggest that the course of labor may be a precipitating factor in the onset and evolution of early ICH.     

极低出生体重儿脑室周围-脑室内出血相关因素分析

目的探讨极低出生体重儿脑室周围-脑室内出血(PVH-IVH)的相关因素。方法回顾性分析2006—2009年本院新生儿科收治的极低出生体重儿,根据是否发生PVH-IVH分为病例组和对照组,比较两组患儿的产前、产时及产后情况,对有意义的因素进行多因素Logistic回归分析。结果共收治极低出生体重儿131例,入选122例,其中病例组60例,对照组62例。病例组胎龄、体重、生后第1天pH值及母亲产前应用糖皮质激素的比例均低于对照组[胎龄(30.9±2.6)周比(31.8±2.3)周,体重(1252±153)g比(1310±140)g,pH值(7.28±0.09)比(7.35±0.08),产前激素16.7%比32.3%,P均<0.05],窒息、机械通气、低血糖的比例均高于对照组(窒息81.7%比46.8%,机械通气28.3%比12.9%,低血糖50.0%比30.6%,P均<0.05)。多因素分析显示,产前应用糖皮质激素、胎龄、体重、窒息和生后第1天pH值是极低出生体重儿发生PVH-IVH的相关因素。结论产前应用糖皮质激素、胎龄、体重、窒息和生后第1天pH值是极低出生体重儿发生PVH-IVH的相关因素,产前应用糖皮质激素可以降低PVH-IVH的发生率。     

Rationale for grading intracranial hemorrhage in premature infants

There is a high incidence of hemorrhage in the germinal matrix and ventricular system in premature infants. Existing systems of grading the extent of hemorrhage into germinal matrix and ventricles of premature babies have limitations. It is necessary to consider correlations of structure (neuroanatomy by ultrasound) with function (outcome of patient). It is suggested that a standardized worksheet for evaluation of cranial ultrasound usage in premature infants be adopted. Such a worksheet allows uniformity of data collection and permits a more efficient method for evaluating correlations of structure with function.     

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目的探讨新生儿颅脑损伤与新生儿窒息的相互关系。方法2004-12—2005-05江西省妇幼保健院对196例新生儿进行颅脑B超探查,并结合临床资料对其结果进行对比分析。结果196例新生儿中共有脑损伤73例,其中早产儿为54例,占早产儿的60%(54/90),足月儿脑损伤为19例,占足月儿的17·92%(19/106),低体重儿脑损伤47例,占低体重儿的56%(47/84),正常体重儿脑损伤为26例,占正常体重儿的23·2%(26/112)。早产儿、低体重儿颅脑损伤发生率分别较足月儿、正常体重儿明显升高,且有显著差异(P<0·01,P<0·05)。早产儿、低体重儿颅脑损伤在对照组与窒息组间无统计学意义(P>0·05),而足月儿、正常体重儿、剖宫产儿颅脑损伤在对照组、窒息组间存在显著差别(P<0·05)。结论新生儿窒息是引起足月儿、正常体重儿、剖宫产儿颅脑损伤的主要因素之一;早产儿、低体重儿脑损伤发生率明显高于足月儿、正常体重儿;减少早产儿、低体重儿的出生,可有效降低新生儿颅脑损伤的发生率;颅脑B超可作为新生儿早期颅脑损伤的诊断、筛查、跟踪随访的重要检查手段之一。     

Behavioral characteristics and early temperament of premature infants with intracranial hemorrhage

Behavioral characteristics of 12 full-term and 44 premature infants with and without intracranial hemorrhage (ICH) were studied. Cranial ultrasonography prospectively documented Grade I-II ICH in 14, Grade III-IV in 19 and no ICH in 11 premature infants. Examination at corrected age of 40 +/- 2 weeks using the Neonatal Behavioral Assessment Scale showed that infants in the ICH groups had lower levels of arousal and more abnormal reflexes than full-terms. Infants with ICH III-IV displayed less optimal motor responses than full-term infants and diminished orientation responses, especially to visual stimuli. Thus, lower level of arousal, immature motoric processes, and poor visual orientation differentiated premature with ICH from full-term infants, although premature infants without these sequelae, did not differ significantly from full-term infants. The above may represent early manifestations of visual-perceptual and motor problems noted in the follow-up of ICH infants. Further, neonatal behavior was found to affect parent ratings of infant temperament (via the Bates Infant Characteristics Questionnaire) at 3 months corrected age, and the relationships between neonatal behavior and parental ratings differed depending upon the infant's gestational age and severity of hemorrhage. We conclude that neonatal behaviors are less optimal in premature infants, and least optimal in premature infants with severe intracranial hemorrhage when compared to fullterm infants.