先天性巨细胞病毒感染脑损伤及康复治疗研究

目的探讨先天性巨细胞病毒(CMV)感染对患儿脑功能的影响及脑康复治疗的疗效。方法以2004年1月至2007年11月在中南大学湘雅二医院新生儿科住院的81例先天性CMV感染患儿为研究对象，在用更昔洛韦治疗的同时，对其进行新生儿行为神经测试(NBNA)、头颅CT或MRI检测及听力检查。部分患儿在脑康复治疗后复查了NBNA测试。结果81例患儿中，NBNA评分异常率为43.03%(34/79)；29例患儿康复治疗后NBNA评分提高，差异有统计学意义。头颅影像学检查异常率为46.27%(31/67)，影像学异常表现为脑实质灶性坏死或脑软化灶、脑发育迟缓、脑实质出血、脑室周围钙化及脑积水。听力筛查未通过率为50.68%(37/73)，确诊听力障碍4例。结论先天性CMV感染易导致脑损伤，对患儿早期进行脑功能监测并给予康复治疗有助于改善其预后。

Study on brain injury and rehabilitation care of newborns with congenital cytomegalovirus infection

ObjectiveTo investigate the abnormal appearance of nervous systerm in the newborns with congenital cytomegalovirus infection.To explore the relations between congenital cytomegalovirus infection and brain injury.MethodsA total of 81 cases with CMV infection received Ganciclovir therapy and adjunct examinations including neonatal behavioral neurological assessment and head CT or MRI and hearing examinations.Some newborns received rehabilitation care.ResultsThirty-four (43.03%)newborns had abnormal NBNA score.NBNA score could be raised after rehabilitation care.Thirty-one(46.27%)newborns had abnormal head imaging appearances such as encephalic necrosis and encephalic hypoplasia，intracranial hemorrhage and intracranial calcification and hydrocephalus.Thirty-seven(50.68%)newborns didn’t pass the first hearing test.Four babies had hearing disorder.ConclusionThe brain injuries following congenital cytomegalovirus infection are common.Adjunct examinations should be performed early and intervention treatment should be done in time to improve the prognosis of newborns.