连续腰穿治疗早产儿重度脑室内出血疗效观察

早产儿因其特殊的解剖结构，易发生颅内出血，以脑室内出血（intraventricular hemorrhage，IVH）最多见，发生率达65％以上，IVH的并发症主要为脑积水，近年来连续腰穿（LP）是治疗IVH较为肯定的方法。自1999年以来，我院新生儿中心对重度脑室内出血早产儿采用LP治疗方法，现将疗效总结如下。     

连续腰穿治疗早产儿重度脑室内出血后脑积水疗效对照研究

早产儿脑损伤中以脑室内出血（IVH）最常见，而重度IVH患儿中约一半以上出现出血后脑积水并发症，多留有神经系统后遗症。目前国内外对采取积极的持续腰椎穿刺方法（LP）治疗和控制重度IVH后脑积水，基本持肯定态度。现将我院15例采用持续LP治疗的重度IVH与同期15例未进行该项治疗的患儿进行对照研究，并进行短期随访。     

连续腰穿治疗新生儿重度脑室内出血的疗效评估(英文)

目的：重度脑室内出血常导致脑积水及其它后遗症,本文评估连续腰穿对新生儿重度脑室内出血(IVH)的疗效。方法：对我院1993年以来30例行连续腰穿(LP)治疗的严重脑室内出血(IVH)患儿进行疗效评估。并与30例未予任何防治IVH后脑积水措施的严重IVH进行对照。结果：经连续LP治疗的30例中,25例患儿的脑室停止扩张并明显缩小,有效率83.3％。初次LP日龄为(15.0±13.5)d,疗程(16.9±12.9)d,平均LP次数(6.4±4.7)次,平均LP间隔时问(2.9±2.7)d,平均每次脑脊液放液量(6.7±1.6)ml。LP治疗后起效时间为(9.6±5.5)d。10例在连续LP同时联用乙酰唑胺治疗,患儿增大的脑室在1-2周左右恢复正常或趋于稳定。25例中18例平均随访(8.3±1.9)月,体格、智能发育均正常,B超显示14例脑室形态正常,4例脑室轻度增大。每次脑脊液放液量>5 ml者及腰穿间隔时间<2 d者有效率明显较高(P<0.05或0.01)。对照组中23例脑室中重度扩张(其中6例并发脑积水),3例失访。结论：连续LP为治疗新生儿严重IVH的安全有效方法,可有效防止脑积水的发生发展。     

苯巴比妥预防早产儿脑室内出血的探讨

目的探讨苯巴比妥预防早产儿脑室内出血(IVH)的效果及与用药时间的关系。方法以1998年1月～2003年5月住院的462例日龄≤24h的早产儿为研究对象 ,设预防组 ,于入院后立即给予苯巴比妥负荷量 ,24h后给予维持量 ,疗程5d ,根据入院时接受苯巴比妥负荷量的日龄将预防组分为3组 ,A组(<6h) ,B组(6～12h) ,C组(12～24h) ;将1996年1月～1997年12月住院的早产儿98例设为对照组即D组 ,未用苯巴比妥 ,比较4组IVH的发生率及严重IVH发生率。结果生后接受苯巴比妥用药时间越早 ,IVH及严重IVH的发病率越低 ,A、B组IVH的发生率分别为15.6 %及32.8 % ,较D组58.2 %显著降低(P<0.01) ;C组IVH的发生率为44.9 %与D组58.2 %对比差异无显著性(P>0.05) ;A、B、C组严重IVH的发生率分别为5.1 % ,10.9 %及26.9 % ,较D组33.7 %明显降低(P<0.01)。结论苯巴比妥预防早产儿脑室内出血的效果关键在于用药时机的掌握 ,以生后6h内应用苯巴比妥预防早产儿脑室内出血效果最佳。     

连续腰穿治疗新生儿脑室内出血的疗效观察及随访

目的　探讨连续腰椎穿刺 (LP)治疗新生儿脑室内出血 (IVH)的疗效及预后。方法　选择 1997年 7月以来我院新生儿科CT确诊的IVHII级以上患儿 5 8例 ,分为同意LP治疗的LP组 2 9例和拒绝治疗的对照组 2 9例 ,进行随访。结果　 2 9例患儿开始LP时间为生后 5～ 10d ,平均 (6 82±0 6 6 )d。LP次数为 5～ 2 5次 ,平均 (12 38± 3 78)次。持续时间 7～ 31d ,平均 (15 6 2± 5 31)d。放液量5～ 15ml,平均 (8 1± 2 7)ml。治愈后 6个月复查头颅CT ,LP组 3例IV级IVH中 2例显示双侧脑室轻度稳定扩大 ,1例发现有外部性脑积水 ,1例III级IVH显示双侧脑室中度扩大 ,余 2 5例正常 ;对照组9例显示双侧脑室中度以上扩大并进行性加重形成脑积水 ,余 2 0例正常。随访时间 10个月～ 6年 ,LP组 2 9例仅 1例III级IVH双侧脑室中度扩大发生脑瘫 ,余 2 8例生长发育正常 ,预后不良发生率 1/ 2 9(3 4 % ) ;对照组发生脑积水的 9例均发展成脑瘫 ,其中 1例随访 2年后死亡 ,预后不良发生率 9/ 2 9(31 0 % )。两组预后比较存在非常显著性差异 (χ2 =7 33,P <0 0 1) ,对照组预后较差。结论　IVHII级以上 ,尤其是严重IVH ,可早期采用积极主动的连续LP治疗 ,对预防IVH导致的脑积水效果显著 ,并可改善IVH患儿的不良预后     

早产儿脑室出血发病机理研究

早产儿脑室内出血（ＩＶＨ）发病率和死亡率高，其发病机理包括血管内因素，血管外因素和血管因素，而脑室周围毛细血管不成熟是ＩＶＨ的主要原因。本文电镜下观察了１４例早产儿和１例儿童侧脑室脉络丛毛细血管内皮，发现胎儿期的内皮无基膜，完整的基膜应在出生后才逐渐发育成熟；冷冻复型标本证实内皮细胞间存在着简单的紧密连接，并随着胎儿发育而成熟。侧脑室脉络丛毛细血管内皮的超微结构特点在早产儿ＩＶＨ发病中起重要作用。     

影响早产儿脑室内出血的相关因素及防治措施

早产儿，尤其是胎龄≤32周的极低出生体重儿，脑室内出血（IVH）的发生率达50％～70％，是引起早产儿死亡和神经系统障碍的重要原因。因此明确影响早产儿IVH的相关因素，并给予相应预防治疗，是临床探讨的重要课题之一。     

应用苯巴比妥预防早产儿脑室内出血九年疗效评估

目的　该文进行九年总结及评价苯巴比妥的实际预防早产儿脑室内出血 (IVH)疗效。方法　回顾 1994年至 2 0 0 3年期间入住新生儿病房、曾经头颅B超检查的早产儿有效病例 331例 ,其中 113例应用苯巴比妥作为预防组 ,接受苯巴比妥负荷量 2 0mg/kg ,分两次间隔 12h静脉给予 ,负荷量 12h后再静脉给予维持量每日5mg/kg ,共 4～ 5d。预防组所有患儿接受苯巴比妥的平均时龄为生后 14 .0h(1～ 72h) ,其中本院患儿为 12 .0h(1～ 72h) ,外院为 17.5h(1～ 4 8h)。 2 18例未用苯巴比妥的患儿作为对照组。结果　对照组中IVH程度更为严重 ,其重度IVH的发生率占出血患儿的 2 1.2 % ,较预防组的重度IVH发生率高出近 15个百分点 ,两组在重度IVH发生率之间的差异呈非常显著性意义 (P <0 .0 1)。预防组中IVH由轻度向重度的转变率为 4 .5 % ,由重度向轻度的转变率为 10 0 %。对照组中IVH由轻度向重度的转变率为 2 3.3% ,由重度向轻度的转变率为 6 .3% ,两组在IVH轻重程度转变之间的差异呈非常显著性意义 (χ2 =13.77,P <0 .0 1和 χ2 =2 5 .78,P <0 .0 1)。结论　对早产儿在生后早期应用苯巴比妥预防IVH具有一定的效果 ,尤其可稳定病情 ,显著减轻脑室内出血的严重度。但需指出的是 ,药物预防并不是减少脑室内出血发生的唯一手     

连续腰穿对重度脑室内出血早产儿脑脊液中非蛋白结合Fe2+和丙二醛水平的影响

目的 探讨连续腰穿对重度脑室内出血(IVH)早产儿脑脊液中非蛋白结合Fe2+和丙二醛(MDA)水平的影响.方法 对20例重度IVH早产儿行连续腰穿治疗,检测首次和末次腰穿脑脊液标本中的非蛋白结合Fe2+和MDA水平,20例对照组早产儿在生后7～14 d内只取一次脑脊液标本.结果 重度IVH组首次腰穿脑脊液中非蛋白结合Fe2+水平[(0.66±0.38) μmol/L]较对照组[(0.24±0.12) μmol/L]高,MDA水平[(1.21±0.41) μmol/L]亦较对照组[(0.89±0.35) μmol/L]高,差异均有显著性(P<0.01,P<0.05);重度IVH伴出血后脑室扩张(PHVD)者在首次和末次腰穿脑脊液中非蛋白结合Fe2+水平[(0.75±0.34) μmol/L、(0.57±0.21) μmol/L]均较未发生PHVD者[(0.54±0.31) μmol/L、(0.35±0.18) μmol/L]升高,差异有显著性(P<0.05),而MDA水平两者差异无显著性;两者在末次腰穿时脑脊液非蛋白结合Fe2+水平均较首次腰穿时降低,差异有显著性(P<0.05),而MDA水平无明显变化.结论 重度IVH早产儿脑脊液中非蛋白结合Fe2+和MDA水平升高,可能与Fe2+和氧自由基参与早产儿脑白质损伤有关,连续腰穿治疗可以降低脑脊液中非蛋白结合Fe2+水平.     

Serum sodium concentration and intraventricular hemorrhage in premature infants

Recent data suggest that early loss of brain tissue water content, ie, decreased extravascular cerebral tissue pressure, may play a role in the pathogenesis of germinal matrix/intraventricular hemorrhage in the premature newborn. This study examines the relationship between the concentration of serum sodium and germinal matrix/intraventricular hemorrhage in 299 premature infants with birth weights of less than 1500 g during the first 4 days of life. Intraventricular hemorrhage developed in 34 (32%) of the 106 infants with maximum serum sodium levels of 145 mmol/L or less and in 54 (28%) of 193 infants whose highest serum sodium levels were greater than 145 mmol/L (chi 2 = 0.37). These data suggest that concentrations of serum sodium greater than 145 mmol/L are not associated with an increased risk of germinal matrix/intraventricular hemorrhage in the premature newborn. Consequently, more liberal administration of fluids to maintain extravascular cerebral tissue pressure is unlikely to reduce the incidence of germinal matrix hemorrhage/intraventricular hemorrhage.     

Ocular outcomes in low birth weight premature infants with intraventricular hemorrhage

PURPOSE: To study ocular outcomes in very low birth weight premature infants with intraventricular hemorrhage. METHODS: Parents of 490 consecutive very low birth weight (less than 1500 g) premature infants who were discharged from the neonatal intensive care unit of our hospital between 1994 and 1996 were asked to enroll their child/children in this cross-sectional study. Sixty infants (12%) were recruited and had complete masked ophthalmologic examinations at 12 months corrected gestational age. The medical records of each infant were reviewed after the eye examination was complete. The occurrence of intraventricular hemorrhage and other perinatal comorbidities was documented. Ocular outcomes of infants with no or low-grade (grades I-II) hemorrhages were compared with those of infants with high-grade (grades III-IV) intraventricular hemorrhage. RESULTS: Of the 60 infants examined, 17 (28%) had neonatal intraventricular hemorrhage. Eleven (18%) had high-grade intraventricular hemorrhage, and 49 (82%) had no or low-grade hemorrhage. Of the 11 infants with high-grade intraventricular hemorrhage, 8 (73%) had strabismus compared with 7 (14%) of 49 infants with no or low-grade hemorrhages who developed strabismus (P<0.001). The high-grade group also had a larger proportion of infants with ocular motility defects (P=0.008), nystagmus (P<0.001), optic nerve atrophy (P<0.001), and abnormal retinal findings (P=0.039). Additionally, these infants were more likely to have stage 3 or worse retinopathy of prematurity (P=0.003). CONCLUSIONS: These results confirm the findings of our earlier retrospective study, and suggest that the occurrence of high-grade intraventricular hemorrhage in the early postnatal period places these infants at significant risk for adverse ocular outcomes. These infants require close ophthalmologic surveillance.     

Prophylactic indomethacin for prevention of intraventricular hemorrhage in premature infants

The impact of early prophylactic use of intravenous indomethacin on the incidence and severity of periventricular-intraventricular hemorrhage and patent ductus arteriosus in 199 oxygen-requiring premature infants (less than or equal to 1300 g birth weight) was prospectively investigated. The trial was controlled, the infants were randomized, and the investigators were unaware of the group assignments. Patients with minimal (grade I) or no periventricular-intraventricular hemorrhage determined by prestudy echoencephalography were randomized within two birth weight subgroups (500 to 899 and 900 to 1300 g) to receive either prophylactic indomethacin (n = 99) or an equal volume of saline-vehicle placebo (n = 100). The first dose (0.2 mg/kg) was given within 12 hours of delivery and two subsequent doses (0.1 mg/kg) were administered at 12 hourly intervals. Prophylactic indomethacin significantly reduced the incidence of grades II to IV periventricular-intraventricular hemorrhage. Intraventricular hemorrhage was half as common in infants given prophylactic indomethacin as in control infants (23% v 46%, P less than .002). The reduction was manifested in both birth weight subgroups. Results of this study also confirmed a lower incidence of clinically significant patent ductus arteriosus in infants who received prophylactic indomethacin in contrast to those who received placebo (11% v 42%, P less than .001). No significant differences were found between treatment and control groups in the duration of oxygen therapy, mechanical ventilation, or hospitalization or in the incidence of pneumothorax, chronic lung disease, sepsis, necrotizing enterocolitis, retinopathy of prematurity, or death. Early prophylactic indomethacin initiated within 12 hours of delivery is effective in reducing the incidence of intraventricular hemorrhage as well as clinically significant patent ductus arteriosus in very low birth weight premature infants.     

Screening head ultrasound to detect intraventricular hemorrhage in premature infants

Objective. The objective of this case-control study was to develop a screening protocol using head ultrasound (HUS) to detect high-grade intraventricular hemorrhage (IVH) in very-low-birthweight infants with greater specificity than current practice, while maintaining a high degree of sensitivity. Materials and methods. All infants ≤ 32 weeks or ≤ 1500 g admitted to the neonatal intensive care unit between January 1, 1991 and December 31, 1992 were studied. The 1991 cohort was analyzed to identify the factors most sensitive and specific for predicting the occurrence of a high-grade (III or IV) IVH. Results. Eighty-five percent of infants born at 28–32 weeks gestation screened by 2 weeks of age for IVH had normal HUS scans. The factors most predictive of a high-grade IVH were gestational age < 28 weeks, forceps delivery, or any of the following in the first 2 weeks of life: seizures, head circumference increasing by more than 1 cm per week, base deficit ≥ 10, or cardiopulmonary resuscitation in the neonatal intensive care unit. Conclusion. Infants born at 28–32 weeks with a high-grade IVH can be identified with a high degree of sensitivity using refined screening criteria, eliminating 50 % of the HUS scans currently obtained for IVH screening. Received: 16 April 1996 Accepted: 16 September 1996     

早产儿脑室内出血的早期诊断和防治

低出生体重儿由于其器官和功能均未成熟 ,生活能力低下 ,死亡率高 ,存活者常出现多种临床问题及后遗症 ,因而低出生体重儿的存活率和生存质量的改善已成为全球性的亟待解决的主要问题之一。根据 1998年 11个省 44个市县调查 ,我国低出生体重儿的发生率为 5 87% [1] ,尽管百分比不算高 ,但因我国每年出生人口总数高达 2 0 0 0万 ,其绝对数显得十分突出。在低出生体重儿所出现的众多临床问题中 ,其危害最大之一为脑室内出血 (ｉｎｔｒａｖｅｎｔｒｉｃｕｌａｒｈｅｍｏｒｒｈａｇｅ ,ＩＶＨ) ,在早产儿中其发生率可高达 65 %以上。早产儿好发…     

低体重早产儿维生素K缺乏与脑室出血的关系

目的　研究低体重早产儿维生素K缺乏状况及其与脑室出血的相关性。方法　采用酶联免疫吸附法 (ELISA)检测 5 4例孕周 <34周、体质量 90 4～ 2 15 7g早产儿静脉血凝血酶原前体蛋白 (PIVKA Ⅱ ) ,并于生后3～ 5d行头颅B超检查 ,诊断有无脑室出血。结果　PIVKA Ⅱ阳性 17例 ,低体重早产儿维生素K缺乏发生率为 31.5 % (17/ 5 4 ) ,低体重早产儿脑室出血发生率为 4 8.7% (19/ 39) ,维生素K缺乏并脑室出血 4例 ,其中重度脑室出血 3例。窒息、低出生体重是主要致病因素。结论　低体重早产儿存在维生素K缺乏 ,相当一部分早产儿存在脑室出血 ,维生素K缺乏虽不是脑室出血的主要致病因素 ,但其他致病因素也可能加重脑室出血的严重程度 ,应予重视     

早产儿脑室内出血高危因素的探讨

目的 采用床旁头部B超研究早产儿脑室内出血(IVH)发病情况,并对相关实验室检查结果 进行分析,以探讨IVH的高危因素.方法 2003年2月至2004年3月我院儿科病房共收治114例早产儿,应用东软NAS-2000型三维彩超诊断仪对早产儿在生后3 d进行床边头部B超检查,探查IVH发病情况;在生后24 h内进行血气分析、血细胞分析、凝血三项测定.结果 114例早产儿中,IVH34例,占29.8%.胎龄28～34周早产儿IVH发病率(43.8%)高于35周以上早产儿(12.0%),1500 g以下早产儿IVH发病率(58.8%)高于1500 g以上早产儿(24.7%),差异均有非常显著性(P＜0.01).与非IVH患儿比较,IVH患儿血红蛋白、血细胞比容明显增高(P＜0.05);凝血酶原时间、部分凝血活酶时间延长(P＜0.01);低氧血症、高碳酸血症、酸中毒发病率增加(P＜0.05).结论 小胎龄、低体重、贫血、血细胞比容增高、血小板计数下降、凝血异常、低氧血症及酸中毒可能与IVH发生有关.