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目的探讨围产期缺氧性脑损伤患儿头颅CT脑室容积的动态变化及其与预后的关系。方法收集本院2002—2008年中重度缺氧缺血性脑病和Ⅲ度以上颅内出血的新生儿病例。根据有无神经系统后遗症分为观察组和对照组。所有入选患儿均于生后3~5天、3~4周及3个月分别行头颅CT检查,测量脑室哈氏值、前角指数、脑室指数和第三脑室宽度,比较两组差异及不同时间段的动态变化,分析各指标与预后的相关性。结果 3~5天时观察组哈氏值、脑室指数和第三脑室宽度均小于对照组[(22.4±14.2)mm比(29.2±4.4)mm,(1.5±0.9)比(2.6±0.7),(1.8±0.4)mm比(1.9±0.4)mm,P均<0.01],前角指数大于对照组[(6.4±2.4)比(5.0±1.3),P<0.01];3~4周时观察组哈氏值和第三脑室宽度均大于对照组[(37.0±9.0)mm比(33.3±2.0)mm,(3.4±1.0)mm比(2.7±0.5)mm,P均<0.01];3个月时观察组哈氏值、脑室指数和第三脑室宽度均大于对照组[(47.4±6.8)mm比(34.3±2.3)mm,(2.4±0.6)比(1.7±0.3),(4.1±0.8)mm比(3.1±0.7)mm,P均<0.01]。不同时间点观察组哈氏值、脑室指数和第三脑室指数均逐渐增加,前角指数逐渐降低。结论侧脑室容积测量在评价急性期脑水肿的程度、脑缺氧后遗改变及估测预后方面具有重要意义,为早期制定个体化干预措施提供了客观依据。
Objective To investigate the dynamic changes of cerebral CT volume in children with perinatal hypoxic brain injury and its relationship with prognosis. Methods The neonates with moderate-severe hypoxic-ischemic encephalopathy and intracranial hemorrhage with Ⅲ degree or more in our hospital from 2002 to 2008 were collected. According to whether the nervous system sequelae were divided into observation group and control group. All children were selected for cranial CT examination at 3 ~ 5 days, 3 ~ 4 weeks and 3 months after birth, Hb value, anterior horn index, ventricular index and third ventricle width were measured, and the differences between the two groups were compared Dynamic changes in different time periods, analysis of the correlation between the indicators and prognosis. Results Hash value, ventricular index and third ventricle width in observation group were lower than those in control group [(22.4 ± 14.2) mm vs (29.2 ± 4.4) mm, (1.5 ± 0.9) vs (2.6 ± 0.7) 1.8 ± 0.4) mm (1.9 ± 0.4) mm, P <0.01, respectively. The anterior horn index was significantly higher than that of the control group [6.4 ± 2.4 vs 5.0 ± 1.3, P <0.01] Hysterius value and third ventricle width were significantly higher than those in control group [(37.0 ± 9.0) mm vs (33.3 ± 2.0) mm, (3.4 ± 1.0) mm vs (2.7 ± 0.5) mm, P <0.01; Hb values, ventricular index and third ventricle width in observation group were significantly higher than those in control group [(47.4 ± 6.8) mm vs (34.3 ± 2.3) mm, (2.4 ± 0.6) vs (1.7 ± 0.3), (4.1 ± 0.8) mm ratio (3.1 ± 0.7) mm, P <0.01]. The Haste’s value, the ventricular index and the third ventricle index of observation group increased gradually at different time points, and the anterior horn index decreased gradually. Conclusion The measurement of lateral ventricle volume is of great significance in assessing the degree of brain edema in acute stage, prognosis of cerebral hypoxemia and estimating prognosis, which provides an objective basis for the early development of individualized intervention measures.