新生儿颅内出血的床旁超声诊断价值

目的探讨床旁超声在新生儿颅内出血诊断中的价值。方法应用床旁超声对2010年11月至2011年4月在北京军区总医院八一儿童医院新生儿科住院的出生0～28 d的287例高危患儿行床旁颅脑超声检查，采用Sonosite公司的Turbo床旁彩色超声诊断仪经前囟分别作冠状切面、矢状切面以及经颞窗横切面连续扫描检查，并动态观察其颅内病变的变化。结果（1）287例患儿中发生颅内出血者65例，患病率22.6％，其中，230例早产患儿发生颅内出血63例，患病率27.4％，57例足月患儿发生颅内出血2例，患病率0.04％；早产儿发生颅内出血的患病率明显高于足月儿（χ^2＝14.87， P＜0.01）。（2）在颅内出血的患儿中，发生室管膜下出血27例（早产儿26例，足月儿1例），占41.5％，脑室内出血31例（早产儿30例，足月儿1例），占47.7％，脑实质出血7例（早产儿7例，足月儿0例），占10.8％。所有经超声检查诊断为颅内出血的病例都经CT检查证实。室管膜下出血的超声表现主要为侧脑室前角外下方有局灶性的强回声，脑室内出血的声像图主要表现为不同程度的脑室增宽，脑室内出现除脉络丛外的不均质回声，脑实质出血的声像图早期表现为脑实质内强回声或较高回声团块，血块吸收后可出现无回声的脑空洞。（3）发生颅内出血高危的患儿大脑中动脉峰值流速（Vs）[（29.2±1.75）cm/s]、舒张期流速（Vd）[（10.8±1.00）cm/s]较正常新生儿减低[Vs：（37.8±1.99）cm/s，Vd：（17.5±1.58）cm/s，P＜0.01]，发生颅内出血高危的患儿大脑中动脉阻力指数（RI）（0.63±0.02）较正常对照组（0.54±0.03）增高（P＜0.01）。结论采取经前囟冠状切面、矢状切面、经颞窗横切面超声检查可满足对新生儿颅内出血定位诊断的需求，床旁超声可动态监测颅内出血变化与治疗效果，且无放射损伤，可重复检查，可为新生儿颅内出血的早期诊断、早期治疗提供依据。

Clinical value of cranial bedside ultrasound in the diagnosis of neonatal intracranial hemorrhage

Objective To evaluate the clinical value of ultrasonography in the diagnosis of intracranialhemorrhage（ICH） in newborns.Methods 287 newborns in our hospital experienced color ultrasonography fromNovember 2010 to April 2011.All these newborns were suspected to have intracranial hemorrhage .Results （1）There were 65 cases of intracranial hemorrhage in 287 neonates.The incidence of ICH was 22.6%.63 cases withICH in 230 premature infant.2 cases with ICH in term infants.The incident in premature infants was significantlyhigher than term infants （ χ^2 =14.87, P 〈0.01）.（2） In those ICH patients,27 cases were diagnosed assubependymal hemorrhage,31 cases were diagnosed as intraventricular hemorrhage and 7 were diagnosed as cerebralhemorrhage.All the patients with ICH were proved by CT.There was no significant difference in type of ICH betweenpremature infants and term infants.（3）In cases with lower Vs[（29.2 ±1.75）cm/s],Vd[（10.8 ±1.00）cm/s]andhigher RI（0.63 ±0.02）of middle cerebral artery,the incidence of ICH was significantly higher than those of higherVs,Vd and lower RI [ Vs： （37.8 ±1.99） cm/s, Vd： （17.5 ±1.58 ） cm/s, RI：0.54 ±0.03, P 〈0.01].Conclusion Ultrasonography can monitor the change of intracranial hemorrhage , and it is a non-invasive,repeatable,cheap and effective examination.It can increase the diagnostic rate of neonatal intracranial hemorrhage ,and the early diagnosis combined with early treatment can lower the mortality and complications of newborns .