床旁颅脑超声在新生儿颅内出血诊断中的应用

目的探讨床旁超声在新生儿颅内出血诊断中的应用价值。方法应用床旁超声对1400例新生儿(男752例、女648例;早产儿1050例、足月儿350例)在出生后3d内行床旁颅脑超声检查并与CT检查结果进行比较分析。结果 (1)新生儿颅内出血患病率:1050例早产儿颅内出血166例,患病率15.81%,其中<32周的早产儿100例(60.2%)、≥32周的早产儿66例(39.8%)。350例足月儿颅内出血38例,患病率10.86%,其中<40周足月儿27例(71.1%)、≥40周11例(28.9%)。早产儿颅内出血患病率高于足月儿(χ2=5.17,P<0.05)。752例男新生儿中出血患儿113例(15.0%),648例女新生儿中出血患儿91例(14.0%),性别比较差异无统计学意义。(2)新生儿颅内出血类型:166例颅内出血早产儿脑室出血155例(93.4%),脑实质出血11例(6.6%);38例颅内出血足月儿脑室出血35例(92.1%),脑实质出血2例(5.2%),硬膜下出血1例(2.6%)。早产儿和足月儿在出血类型和脑室出血程度上差异无统计学意义。(3)204例新生儿颅内出血病例中,141例(69.1%)有明显异常围生史,其余63例(30.9%)无明显异常围生史。结论低胎龄早产新生儿颅内出血患病率较高,部分患儿无明显临床表现及异常围生史,应进行常规筛查。床旁超声检查能够为新生儿颅内出血诊断提供可靠、准确的信息,并且便捷、无创、易于随访,应作为筛查、监测新生儿颅内出血的首选方法。

Application of bedside ultrasound in diagnosis of intracranial hemorrhage in neonates

Objective To evaluate the diagnostic value of bedside ultrasound in diagnosis of the intracranial hemorrhage （ICH） in neonates.Methods A total of 1400 neonates （male 752,female 648;premature infant 1050,term infant 350） were examined by bedside ultrasound in 3 days after born.Results （1）Incidence of ICH：166 （15.81%） cases with ICH in 1050 premature infants.Of these 166 cases,100 （60.2%） were less than 32 weeks and 66 （39.8%） were more than 32 weeks premature infants.A total of 38 （10.86%） cases with ICH in 350 term infants.Of these 38 cases,27 （71.1%） were less than 40 weeks and 11 （28.9%） were more than 40 weeks term infants.The incidence in premature infants was significant higher than term infant.（2）Types of ICH：155 cases （93.4%） with intraventricular hemorrhage （IVH） and 11 cases （6.6%） with cerebral hemorrhage in premature infants.35 cases （92.1%） with Intraventricular hemorrhage,2 cases （5.2%） with cerebral hemorrhage and 1 case with subdural hemorrhage in premature infants.There was no significant difference in types of ICH and grade of IVH between premature infants and term infants.（3）Of 204 cases with ICH,141 （69.1%） had obviously abnormal perinatal history but 63 （30.9%） had not.Conclusions Neonates,especially the premature infants with low gestational age have the higher incidence of ICH.Bedside ultrasound could provide reliable and precise information on ICH in neonates.For bedside ultrasound is convenient,noninvasive and easily follow-up,it should be the preferred method for screening and monitoring ICH in neonates.