足月儿,颅内出血,神经外科手术,颅脑超声,头颅计算机断层扫描," /> 足月儿,颅内出血,神经外科手术,颅脑超声,头颅计算机断层扫描,"/> Term neonate,Intracranial hemorrhage,Neurosurgical procedures,Cerebral ultrasound,Cranial CT,"/> 足月新生儿颅内出血手术治疗及随诊分析
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发育医学电子杂志  2020, Vol. 8 Issue (2): 173-177    DOI: 10.3969/j.issn.2095-5340.2020.02.015
  围产医学   临床经验交流 |新生儿 |
足月新生儿颅内出血手术治疗及随诊分析
颜晓丹 李冰肖 韩莎莎 等
暨南大学第一附属医院 新生儿科,广东 广州 510000
Neurosurgical management and follow-up for intracranial hemorrhage in term neonates
Yan Xiaodan, Li Bingxiao, Han Shasha, et al
Neonatology Department, The First Affiliated Hospital of Ji'nan University, Guangdong, Guangzhou 510000, China
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摘要 【摘要】 目的 探讨新生儿颅内出血(neonatal intracranial hemorrhage,NICH)的高危因素、临床表现、手术疗效及预后,以提高认识、早诊断、早治疗。 方法 2012 年6 月至2014 年7 月,暨南大学第一附属医院收治的NICH 足月患儿中,4 例接受手术治疗并定期随诊至学龄前期。采用回顾性分析的方法,记录这4 例患儿围产期相关情况、临床表现、实验室检查、手术治疗情况及预后。 结果 4 例患儿均存在围产期相关高危因素(脐带异常、胎心下降、头盆不称、阴道试产失败转剖宫产、羊水污染等);均不以神经系统异常为首发症状。颅脑超声检查均有阳性发现,头颅CT 进一步确诊了颅内出血的类型和出血量,病例1 双侧侧脑室及第三脑室增宽;病例2 头皮下血肿及硬膜下出血,颅骨移位;病例3 硬膜外血肿;病例4 脑实质内出血脑疝。3 例患儿急诊行开颅血肿清除术,1 例患儿保守治疗3 d 后行侧脑室转孔引流术。4 例患儿出院后随访至学龄前,预后均良好。 结论 足月儿NICH 与围产期因素有关,早期临床表现缺乏特异性,建议尽早行头颅超声筛查和CT 确诊,及时手术治疗可以改善预后。
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关键词:  font-size:14px  足月儿')" href="#">">足月儿  颅内出血  神经外科手术  颅脑超声  头颅计算机断层扫描    
Abstract: 【Abstract】 Objective To explore the high-risk factors, clinical manifestations, surgical efficacy and prognosis of intracranial hemorrhage in newborns to improve cognition and early diagnosis and treatment. Methods From June 2012 to July 2014, in the admitted full-term newborns who were diagnosed as neonatalintracranial hemorrhage (NICH) in The First Affiliated Hospital of Ji'nan University, four cases received surgical treatment and regular follow-up until preschool. The perinatal situation, clinical manifestation, laboratory examination, surgical treatment and prognosis of the four cases were analyzed retrospectively.
Results The four cases all had perinatal high-risk factors (abnormal umbilical cord, decreased fetalheart rate, cephalopelvic disproportion, cesarean section due to failure of vaginal delivery, amniotic fluidcontamination, etc.). The first symptom was not nervous system abnormality in the four cases. In brainultrasonography, they all showed positive findings. The type and amount of intracranial hemorrhage werefurther confirmed by CT. Case 1: bilateral lateral ventricles and third ventricles were widened. Case 2:subdural hematoma and subdural hemorrhage, and cranial displacement. Case 3: extradural hematoma. Case4: intracerebral hemorrhage combined with cerebral hernia. Three cases underwent emergency treatment andgot removal of hematoma by craniotomy. Case 1 had conservative treatment for three days, then accepted thelateral ventricle drainage. Four children were followed up after discharge until preschool, and they all hadsatisfactory prognosis. Conclusions The NICH of full-term newborns may be related to perinatal factors.The early clinical manifestations lack specificity. Early head ultrasound screening and CT diagnosis arerecommended, and timely surgical treatment can improve the prognosis.
Key words:  font-size:14px    Term neonate')" href="#">">Term neonate    Intracranial hemorrhage    Neurosurgical procedures    Cerebral ultrasound    font-size:14px    Cranial CT')" href="#">">Cranial CT
收稿日期:  2019-09-25                出版日期:  2020-04-30      发布日期:  2020-04-23      期的出版日期:  2020-04-30
基金资助: 国家自然科学基金应急管理项目(81741083);国家自然科学基金青年项目(81801492)
通讯作者:  柳国胜https://teacher.zjut.cc/t1356701/    E-mail:  tlgs@jnu.edu.cn
引用本文:    
颜晓丹 李冰肖 韩莎莎 等. 足月新生儿颅内出血手术治疗及随诊分析[J]. 发育医学电子杂志, 2020, 8(2): 173-177.
Yan Xiaodan, Li Bingxiao, Han Shasha, et al. Neurosurgical management and follow-up for intracranial hemorrhage in term neonates. Journal of Developmental Medicine(Electronic Version), 2020, 8(2): 173-177.
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http://www.fyyxzz.com/CN/10.3969/j.issn.2095-5340.2020.02.015  或          http://www.fyyxzz.com/CN/Y2020/V8/I2/173
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