摘要
目的探讨连续腰椎穿刺(LP)治疗重度脑室内出血(IVH)的早产儿疗效。方法2004年1月~2006年9月期间床边头颅超声确诊的重度IVH的早产儿共30例,分为连续LP治疗组及拒绝治疗的对照组,各l5例;所有患儿出院后均定期随访3~9月,复查头颅超声,并在生后6个月左右行贝利婴幼儿发育量表评分。结果连续LP治疗开始日龄为7d^35d,平均14.1d,间隔天数为1~5d,平均2.5d,每次放液量为4~9m1,平均6.2ml,次数为2~11次,平均7.2次,疗程为6~30 d,平均14.5d。经LP治疗后,住院期间超声显示脑室恢复至正常6例;脑室略大于正常4例,4例无明显疗效,有效率为66.7%(10/15例)。生后3~9月的随访结果显示,治疗组9例脑室大小正常,2例脑积水,1例轻度增大,脑积水发生率13.3%(2/15)。对照组患儿有8例(53.3%)出现脑积水,与治疗组相比,有统计学意义(χ2=5.4,P=0.02),5例为轻度脑室扩大,2例脑室正常。LP治疗组患儿6个月智力和运动发育指数分别为83.8±17.1、88.8±20.9,而对照组分别为72.3±14.1、71.4±13.9,P值分别<0.05及0.01。结论积极的持续LP治疗可望降低重度IVH早产儿出血后脑积水的发生率,改善他们的不良预后。
Objective: To explore the effect of serial lumbar punctures (LP) in treating preterm infants with severe intraventricular hemorrhage (IVH) on the occurrence of posthemorrhagic hydrocephalus. Methods: 30 preterm infants with grade Ⅲ - Ⅳ IVH diagnosed by bedside cranial ultrasound were were devided into two groups: LP treatment group (15 cases) and control group (15 cases) since Jannuary 2005 to September 2006. Then short term (3 -9 months later) follow -up was carried out. Barley infant development marks of two groups during 6 months were compared. Results: 15 cases aged 7 to 35 days (average 14. 1 ) were treated with serial LP 2 to 11 taps (average 7. 2) with interval of 1 to 5 days, (average 2. 5) for 6 to 30 days (average 14. 5) and removal of cerebrospinal fluid was 4 - 9 ml ( average 6. 2). Cranial ultrasound was performed during hospitalization and normal bilateral ventricles was found in 6 of 15 cases in LP group. 4 cases were found bilateral ventricles moderate enlargement and the remain 4 cases were ineffective. 3 - 9 months later bilateral ventricles of 9 cases in LP group were normol, 2cases were found hydrocephalus, 1 case remained moderate enlarged. 8 cases of control group were found hydrocephalus. The rate of hydrocephalus between two groups was different (X^2 = 5.4, P = 0. 02). 5 cases were found moderate enlarged and only 2 cases were normal. Six months aged intelligence and movement development index of LP group were 83.8 ± 17. 1 and 88. 8 ± 20. 9, However those of control group were 72.3 ± 14. land 71, 4 ± 13.9, and P value was less than 0. 05 and 0, 01. Conclusion: Active serial LP treatment can decrease the rate of posthemorrhagic hydrocephalus in preterm infant with severe IVH and improve outcome.
出处
《中国优生与遗传杂志》
2007年第6期83-84,共2页
Chinese Journal of Birth Health & Heredity
关键词
连续腰椎穿刺
脑室内出血
Barley婴幼儿发育评分
出血后脑积水
早产儿
Serial lumbar punctures
Intraventricular hemorrhage Barley infant development mark
Posthemorrhagic hydrocephalus
Preterm infant