足月新生儿缺氧缺血性脑病的早期评估

目的　 探讨通过临床分度 ,新生儿行为测定 ,脑部CT对足月新生儿缺氧缺血脑病的患儿进行早期评估 ,判断预后 ,以便早期干预治疗。 方法 　按照 1996年杭州会议修定的HIE临床分度标准 ,轻度 13例 ,中度 2 7例 ,重度 14例 ,同时对其采用新生儿行为神经测定进行评估 ,头颅CT扫描检查 ,并随访至 6个月时进行发育商评估 ,以DQ≥ 90为达标水平。 结果　临床分度为轻、中度HIE者在 6个月时DQ达标率无显著差异。轻、中、重度HIE患儿在不同日龄NBNA评分有显著差异性 (P <0 0 0 1) ,临床分度越重 ,NBNA评分越低。 14d时NBNA≥ 35分和 <35分者在 6个月时DQ达标率有显著差异性 ,对判断HIE预后有较大的价值。临床分度与颅脑CT分度符合率 80 8% ,CT分度轻、中度在 6个月时DQ达标率无显著差异性 ,中与重度有显著差异性 ,与预后有关。 结论 　只有将临床分度、NBNA评分、头颅CT三者结合起来 ,综合分析才能早期准确地判断HIE的程度和预后。

Early evaluation on outcome of hypoxia-ischemia encephalopathy in term newborn infants

Objective NBNA and brain CT scanning,In order to judge prognosis of full term newborns suffered from hypoxia ischemia encephalopathy(HIE) by clinical grading,and take immediate therapy.Methods 54 infants were divided into 3 groups according to the standard of HIE clinical grading,there were 13 in mild degree,27 in moderate degree,14 in serious degree.Then they were evaluated by Neonatal Behavioral Neurological Assessment(NBNA) examined by brain CT scanning,followed up by Developmental Quotient (DQ) until six months.Results There was no significant difference in the rate of normal DQ at six months between mild and moderate degree of HIE newborns significant differneces were noted at different day in NBNA score was.There was significant difference in the rate of DQ reaching standard by six month between the HIE newborn with NBNA more than 35 and those with NBNA less than 35.The coincident rate between clinical grading and brain CT scanning was 80 8%.There was significant difference in the rate of DQ reaching standard by six month between morderate and severe degree of HIE evaluated by brain CT scanning.Conclusion only the clinical grading,NBNA and brain CT scanning were combined,could be early and exactily judged the degree and prognosis of HIE.