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。     

微创手术治疗婴儿晚发型维生素K缺乏致颅内出血

目的探讨微创手术治疗婴儿晚发性维生素K缺乏致颅内出血的疗效. 方法总结分析微创手术治疗25例婴儿晚发性维生素K缺乏致颅内出血的临床资料. 结果25例患儿均治愈,死亡率为0%,21例获得3月～9年随访,其中17例无任何神经系统后遗症,3例智力发育落后,1例癫痫.结论对婴儿维生素K缺乏致颅内血肿采取微创手术是一种非常有效的治疗手段.     

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28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21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。     

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。     

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.     

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。     

迟发性维生素K缺乏并颅内出血临床分析

目的 探讨维生素K缺乏症并颅内出血误诊原因、诊断、手术治疗及其预后。方法 回顾性分析我院自1994年1月至2002年收治的维生素K缺乏症并颅内出血患儿48例。结果 本组48例，临床治愈27例，好转10例，放弃治疗3例，死亡8例；其中18例手术中，15例治愈，2例好转，1例死亡。结论 迟发性维生素K缺乏并颅内出血，见于新生儿和婴儿，发病突然，部分病例有前驱感染和使用抗生素的病史，易于误诊。CT检查、PT检验和维生素K治疗可有效确诊。对有手术指征，手术治疗可以提高治愈率，降低死亡率，改善生存质量。     

微创治疗在婴儿晚发维生素K缺乏致颅内出血中的应用价值

目的评价微创治疗在婴儿晚发维生素K缺乏致颅内出血中的应用价值。方法选择给予微创治疗的49例晚发维生素K缺乏致颅内出血患儿为观察组,另选择同期给予保守治疗的48例同类患儿为对照组,比较2组临床效果。结果观察组有效率高于对照组(P0.05);观察组致残率低于对照组(P0.05)。结论微创治疗婴儿晚发维生素K缺乏致颅内出血疗效显著,能够有效降低致残率,改善患儿大脑功能,具有较高的临床价值。     

16例婴幼儿迟发型维生素K缺乏致颅内出血临床分析

目的 探讨婴幼儿迟发型维生素K缺乏致颅内出血的临床特征.方法 回顾性分析16例婴幼儿迟发型维生素K缺乏致颅内出血的临床资料.结果 纯母乳喂养为婴幼儿迟发型维生素K缺乏致颅内出血的主要原因,合并胃肠道感染及用抗生素是主要影响因素,预防性应用维生素K可减少或避免迟发型维生素K缺乏致颅内出血的发生.结论 对于纯母乳喂养的患儿应预防性应用维生素K,避免迟发型维生素K缺乏致颅内出血.     

Cortical spreading depression and central pain networks in trigeminal nuclei modulation: time for an integrated migraine pathogenesis perspective

Deficiency of vitamin K predisposes to early, classic or late hemorrhagic disease of the newborn (HDN); of which late HDN may be associated with serious and life-threatening intracranial hemorrhage. Late HDN is characterized intracranial bleeding in infants aged 1 week to 6 months due to severe vitamin K deficiency. Late HDN is still an important cause of mortality and morbidity in developing countries where vitamin K prophylaxis is not routinely practiced. Children with cholestatic liver disease are at risk for developing secondary vitamin K deficiency because of fat malabsorbtion and inadequate dietary intake. In this study, we described 11 infants with cholestatic liver disease with different etiologies exhibiting intracranial hemorrhage (ICH). Six patients underwent surgical evacuation of ICH, following the administration of vitamin K and/or fresh frozen plasma. The possibility of cholestatic liver disease should be considered in the treatment of ICH due to vitamin K deficiency.     

口服华法令合并外伤性颅内出血患者的围手术期处理

目的 探讨长期口服抗凝药物华法令合并外伤性颅内出血患者的围手术期处理措施.方法 10例此类患者入院后给予维生素K、新鲜冰冻血浆和凝血酶原复合物来逆转患者的抗凝状态.9例患者接受开颅手术清除颅内血肿.3例患者术后接受预防剂量的低分子肝素的治疗.结果 术后所有患者均存活,其中5例恢复良好,3例遗留不同程度的偏瘫或失语症状,2例患者术后长期植物状态生存.结论 伤后、术前迅速纠正凝血指标参数至关重要,与患者预后密切相关.

Abstract：

Objective To study the perioperative management in the treatment of traumatic intracranial hemorrhage in patients with pretraumatic anticoagulation therapy of oral warfarin. Method 10 patients of traumatic intracranial hemorrhage with pretraumatic anticoagulation therapy of oral warfarin received vitamin K, FFP and PCC treatment to reverse the anticoagulation condition after admission. 9 patients underwent the operation for evacuation of intracranial hematoma. Low - molecular - weight heparin was administered as prophylactic dose in 3 patients. Results All patients in this group were survival. 5 of them get well recovery. 3 of them remained different degrees of hemiplegia or aphasia and 2 patient got vegetative state after operation. Conclusions Pre - operative normalization of coagulation capacity is of utmost importance in patients with head injury and plays an important role in the prognosis of patients.     

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。     

Prophylaxis of intracranial hemorrhage due to vitamin K deficiency in infants

To determine the most effective way of preventing intracranial hemorrhage due to vitamin K deficiency in infants, we first performed a comparative study using Normotest on the effects of several regimens for the oral administration of vitamin K2. Based on the results, we gave vitamin K2 orally, 2 mg, at birth, and then, 4 mg, at 1 week of age (on discharge from the newborn nursery) to all infants except premature and low-birth-weight infants born in Nagasaki Prefecture, Japan. Since then, as the number of infants with vitamin K2 prophylaxis increased, patients with intracranial hemorrhage due to vitamin K deficiency decreased in number, and no patient was found in 1984. The incidence of this disease in infants with vitamin K prophylaxis was 1/68,500, which was one-twentieth of that (1/3,500 live births) before the period when most neonates received vitamin K prophylaxis. From the results, we concluded that the oral administration of vitamin K2 at birth and 1 week of age prevents this disease.     

Intracranial hemorrhage in an infant owing to vitamin K deficiency despite prophylaxis

A 3-month-old male infant with intracranial hemorrhage attributable to a vitamin K deficiency is reported. Vitamin K2 was administered orally at birth and then at 5 days and 1 month of age. Oral antibiotics were also given 2 days before the onset of bleeding. Although the incidence of intracranial hemorrhage resulting from vitamin K deficiency has decreased since the introduction of vitamin K2 prophylaxis, spontaneous intracranial hemorrhages are still being reported in infants. We suggest that vitamin K prophylaxis is needed especially for breast-fed infants and for those undergoing antibiotic therapy. Received: 17 January 1998 Revised: 20 January 1999     

Incidence and causes of intracranial hemorrhage in infancy: a prospective surveillance study after vitamin K prophylaxis

In order to evaluate the effect of vitamin K prophylaxis on the incidence of intracranial hemorrhage (ICH) in infants aged from 1 week to 12 months, a prospective surveillance study, from 1974 to 1988, was performed on the well-defined population of Nagasaki Prefecture, Japan. The incidence of ICH in infancy markedly decreased, from 34.3/100,000 to 10.1/100,000 live births, with the oral administration of vitamin K2 at both birth and 1 week, or with additional supplementation at 1 month of age. The diminished incidence was attributed to the decreased occurrence of acute ICH due to late hemorrhagic disease (LHD), a late onset form of vitamin K deficiency, and chronic subdural hematoma. On comparing the possible etiological factors, and clinical and laboratory findings between these 2 groups, it became apparent that chronic subdural hematoma shared some etiological factors (such as breast-feeding, liver dysfunction and no supplementation of vitamin K) with LHD. Furthermore, chronic subdural hematoma developed in some patients who had previously had acute ICH due to LHD. These findings suggest that coagulopathy due to vitamin K deficiency, including LHD, is causally related in the majority of, if not all, cases of chronic subdural hematoma without any history of trauma or central nervous system infections.