摘要
目的探讨早产儿脑损伤的危险因素及核磁共振成像(magnetic resonance imaging,MRI)对早产儿脑损伤的诊断价值。方法收集作者医院2014-10/2016-03月131例早产儿的头颅MRI检查资料及相关临床资料。采用McNemar检验比较不同MRI序列诊断缺氧缺血性脑损伤的敏感性。采用χ~2检验比较不同胎龄早产儿发生脑损伤的患病率,采用二分类Logistic回归分析探讨早产儿脑损伤的临床相关危险因素。结果弥散加权成像(diffusion weighted imaging,DWI)序列诊断缺血性脑损伤的敏感性显著高于T1加权像(T1 weighted image,T1 WI)、T2加权像(T2weighted image,T2 WI),且差异具有统计学意义(P<0.05);早产儿脑损伤总患病率23.66%,胎龄越低患病率越高,不同胎龄组间比较差异具有统计学意义(P<0.01),但不同脑损伤类型中仅脑室周围-脑室内出血患病率在不同胎龄早产儿间存在统计学差异(P<0.01)。机械通气、复苏抢救史、低钠血症、顺产是早产儿出血性脑损伤的危险因素,低Appgar评分(5分)、母孕期感染、母孕期糖尿病是早产儿缺氧缺血性脑损伤的危险因素。结论 T1 WI-T2 WI与DWI相结合的MRI检查方式可以提高早产儿脑损伤检出敏感性,早产儿顺产、需要复苏抢救,产后需要机械通气、发生低钠血症出现脑出血的风险更大;而分娩前母亲感染、患糖尿病,以及分娩时窒息则可能发生缺氧缺血性脑损伤。
Objective To discuss clinical risk factors of brain injury in preterm infants and the application value of magnetic resonance imaging （MRI） in diagnosis of brain injury. Methods MRI and clinic data were collected among preterm infants with gestational age 〈37 weeks, who were admitted to neonatal intensive care unit （NICU） in authors＇ hos- pital from October 2014 to March 2016. McNemar test was adopted to compare the sensitivity of MRI plain scan imag- ings. T1 weighted image （TIWI）, T2 weighted image （T2WI） and diffusion-weighted imaging （DWI） for diagnosis of hy- poxic ischemic brain injury. The incidences of brain injury in different gestational age of preterm infants were compared by test. Clinic correlation factors on brain injury were explored with logistic regression analysis. Results The sensitivity in diagnosis of hypoxic ischemic brain injury by DWI sequence was significantly higher than that by T1WI or T2WI （P〈 0. 05）. The total incidence of brain injury was 23. 66%. Gestational age of 28 less than 32 weeks preterm infants were significantly higher than gestational age of 32 less than 34 weeks and 34 less than 37 weeks （P〈0. 01）. There was signif- icantly different in the incidence of periventricular-intraventricular hemorrhage among all brain injury types of preterm in- fants with different gestational age （P〈0. 01）. Mechanic ventilation, resuscitation, hyponatremia and vaginal delivery were risk factors of hemorrhagic brain injury. Low Appgar scores （5 scores）, gestational infection and gestational diabetes mellitus were risk factors of hypoxic ischemic brain injury. Conclusion T1WI-T2WI combine with DWI sequence can increase the positive rate of detecting brain injury in preterm infants. Preterm infants with vaginal delivery, resuscitation, mechanic ventilation and hyponatremia have more risks of cerebral hemorrhage, and those with mother＇s ante partum in- fection, gestational diabetes mellitus and hypoxia have more risk of hypoxic ischemic brain injur
出处
《华南国防医学杂志》
CAS
2017年第6期387-389,共3页
Military Medical Journal of South China
关键词
核磁共振成像
脑损伤
早产儿
危险因素
Magnetic resonance imaging
Brain injury
Preterm infants
Risk factors
