摘要
目的分析近年来收治的58例新生儿脑梗死病例的临床资料及预后，为临床诊治提供可借鉴的经验。方法对复旦大学附属儿科医院新生儿科1999年1月至2010年12月收治的58例新生儿脑梗死病例的临床资料及随访结果进行回顾性分析。结果58例脑梗死患儿中52例为足月儿，6例为早产儿。缺血性梗死51例（占87．9％），出血性梗死7例（占12．1％）。围产期缺氧缺血是最常见的高危因素（占46．6％）。惊厥是新生儿脑梗死最常见的首发症状及病程中最多见的临床表现（占77．6％），其次为阵发性青紫、呼吸暂停及反应差。新生儿脑梗死最易累及大脑中动脉，且左侧多见。新生儿脑梗死急性期以支持和对症治疗为主。预后不良的患儿中，梗死多累及深部灰质核团或波及多个脑叶。结论围产期缺氧是常见的高危因素。惊厥是最常见的早期临床表现。弥散加权成像技术对急性期脑梗死的诊断价值较高。不良预后的患儿中，梗死多累及深部灰质或范围较广。早期发现、结合头颅影像学检查作出诊断，对于指导康复治疗、改善预后有积极的意义。
Objective Cerebral infarction （CI） is one of severe diseases of central nervous system in neonates, and some infants with CI could have poor prognosis in the long term. This study aimed to analyze the clinical data and prognosis of all neonatal cases with cerebral infarction in recent years and to help future clinical work. Method Totally 58 neonatal cases with CI admitted to NICU of the hospital from January 1999 to December 2010 were included in this study. We analyzed all clinical data and prognosis by retrospective analysis. Results Fifty-two term babies and six preterm babies were included. There were altogether 51 cases with asphyxia and 7 with hemorrhagic cerebral infarction. Perinatal hypoxia-ischemia was the most common high-risk factor and it accounted for 46. 6%. Seizure was the most frequent initial symptom and the most common clinical manifestation （ accounted for 77. 6% ）, and it was followed by intermittent cyanosis, apnea and lethargy. Cerebral CT scan and magnetic resonance imaging were major methods to help to make the diagnosis and they also had close relation with prognosis. Diffusion weighted imaging was very helpful to diagnose infarction in early stage. Left middle cerebral artery was the most common artery to be involved. Supportive therapy and symptomatic treatment were the main methods in the acute stage of neonatal cerebral infarction. Those babies with poor prognosis mostly had large infarction involving cerebral hemisphere, thalamus and basal gangli^L Conclusions Neonatal cerebral infarction was a severe brain injury affecting long tern nervous system prognosis. Perinatal hypoxia was the most common high-risk factor and seizure was the most frequent initial symptom. Diffusion weighted imaging was valuable to diagnose infarction in early stage. Most of infants with poor prognosis had large infarction involving hemisphere, thalamus and basal ganglia. Early diagnosis with brain imaging would be helpful for rehabilitation therapy and improving prognosis.
出处
《中华儿科杂志》
CAS
CSCD
北大核心
2013年第1期16-20,共5页
Chinese Journal of Pediatrics
关键词
脑梗塞
婴儿
新生
神经病学表现
磁共振成像
Brain infarction
Infant,newborn
Neurologic manifestations
Magnetic resonance imaging
