足月新生儿缺氧缺血性脑病的CT诊断及临床分析

目的回顾性分析我院87例经临床和CT确诊的围产期缺氧缺血性脑病(HIE)病例,结合有关文献进行分析讨论,旨在提高对本病的诊断水平,为临床治疗及预后评估等方面提供客观的依据。方法87例新生儿缺氧缺血性脑病中,男52例,女25例。胎龄38周至42周,检查时间从出生后1小时至16天。其中顺产39例,胎儿吸引器助产11例,产钳助产9例,剖腹产6例。所有病例都有不同程度的窒息史。结果CT表现为两侧脑室周围脑白质和灰质呈弥漫性或两侧不对称性低密度影,CT值约10～18HU,边界模糊,大脑灰白质分界不清,脑室不同程度受压变窄甚至完全消失。其中伴有蛛网膜下腔出血34例,占本组病例39.1%;脑实质出血24例,占27.6%;脑室内出血15例,占17.2%;硬膜下出血5例,占5.7%;另头皮血肿11例,颅骨骨折4例。结论HIE的程度和发展不同,其颅内有不同的影像学改变。HIE的CT检查能直观地反映新生儿大脑缺氧缺血的程度和范围,并能根据CT表现及脑水肿大小范围进行分度,为临床诊断和治疗及预后评估提供客观依据。

CT image and clinical analysis of the term neonatal hypoxic-ischemic encephalopathy

Objective This is a retrospective investigation of 87 cases of perinatal HIE diagnosed in Junan hospital with literature review,made to improve the diagnosis of HIE,and provide objective information as well as the principle for clinical management and prognosis.Methods In total 87 patients with HIE,including 52 males and 25 females,aged from 38 weeks to 42 weeks,underwent examination in 1 hour to 16 days after the delivery.There was natural labor in 39 cases,vacuum labor in 11 cases,forceps delivery in 9 cases,abdominal delivery in 6 cases.All the neonatal infants had a history of asphyxia on different levels.Results CT scan showed diffuse or asymmetrical hypodense shadows with poorly-defined border,where the CT value measured between 10-18 HU,accompanying with the displacement or even absence of lateral ventricle.Subarachnoid hemorrhage(SAH)were found in 34 cases(39.5%),parenchyma hemorrhage in 24 cases(27.6%),intraventricular hemorrhage(IVH)in 15 cases(17.2%),and subdural hemorrhage in 5 cases(5.7%).Additionally,scalp turgidity was seen in 11 cases,and skull fracture in 4 cases as well.Conclusion The CT scan shows the anoxic-asphyxial lesions in the brain resulting from asphyxiation in neonatal,and the severity is rated with CT manifestation and brain edema,which provide objective guidance of the prognosis and the clinical management of HIE.