新生儿缺氧缺血性脑病临床与神经病理研究

目的研究新生儿缺氧缺血性脑病(HIE)的临床特点和神经病理改变。方法回顾性分析52例死亡HIE患儿的临床特点,目视和光镜观察脑组织病理变化。结果所有患儿均为异常分娩,宫内窘迫占53．8％,产时窒息占38．5％,足月儿多发．占60％．临床表现多样,惊厥发生率高达75％,且多在生后48h之内发生。88％脑组织重量增加,25％超过正常均值加一个标准差,12％低于正常均值;均有不同程度脑水肿,神经细胞肿胀、变性及坏死,部分伴有颅内出血及软化灶形成;脑缺氧缺血易感区与胎龄有关,足月儿以皮质层状坏死为主,早产儿多为室管膜下-脑室内出血;宫内窘迫的足月小样儿脑损害程度更重;蛛网膜下腔出血(SAH)发生率高达63％,且以渗出性出血为主。结论研究HIE的临床与神经病理联系有助于揭示HIE发病机制及指导治疗。

Study the clinical manifestations and changes of neuropathology on neonates with hypoxic-ischemic encephalopathy (HIE)

Objective To study the correlation between clinic findings and neuropathology on neonates with HIE. Methods The study respectly analyzed the clinical manifestations and changes of neuropathology in 52 neonates died of HIE. Results All neonates born abnormity. The neonates died of asphyxia of uterine occupied 53. 8% ,intrapartum asphyxia occupied 38. 5% ,full-term neonates occupied 60%. The incidence of convulsion was 75% and convulsion occured within 48 hours after birth. The weight of brain increased in 88% neonates. The weight of brain exceeded mean value adding a standard deviation in 25% neonates,the weight of brain was lower than normal mean value in 12% neonates. All neonates had different degrees of cerebral edema, nerve cell swelling .degeneration and necrosis. Some neonates had intracranial hemorrhage and malacia forming. There were different changes of neuropathology in defferent gestational age of neonates. The chief change was layer necrosis of cortex in full-term neonates. The incidence of intraventricular hemorrhage was high in preterm neonates. There were severe changes of neuropathology in small for gestational age of full-term neonates. The incidence of sub-arachnoid hemorrhage was 63% and primary bleeding was the most common type. Conclusion The investigation of the correlation between clinic and neuropathology can assist in revealing the pathogenesis of HIE and directing treatment.