连续腰穿治疗新生儿重度脑室内出血的疗效评估(英文)

Effects of Serial Lumbar Puncture on Severe Intraventricular Hemorrhage of Neonates

摘要:

目的：重度脑室内出血常导致脑积水及其它后遗症,本文评估连续腰穿对新生儿重度脑室内出血(IVH)的疗效。方法：对我院1993年以来30例行连续腰穿(LP)治疗的严重脑室内出血(IVH)患儿进行疗效评估。并与30例未予任何防治IVH后脑积水措施的严重IVH进行对照。结果：经连续LP治疗的30例中,25例患儿的脑室停止扩张并明显缩小,有效率83.3％。初次LP日龄为(15.0±13.5)d,疗程(16.9±12.9)d,平均LP次数(6.4±4.7)次,平均LP间隔时问(2.9±2.7)d,平均每次脑脊液放液量(6.7±1.6)ml。LP治疗后起效时间为(9.6±5.5)d。10例在连续LP同时联用乙酰唑胺治疗,患儿增大的脑室在1-2周左右恢复正常或趋于稳定。25例中18例平均随访(8.3±1.9)月,体格、智能发育均正常,B超显示14例脑室形态正常,4例脑室轻度增大。每次脑脊液放液量>5 ml者及腰穿间隔时间<2 d者有效率明显较高(P<0.05或0.01)。对照组中23例脑室中重度扩张(其中6例并发脑积水),3例失访。结论：连续LP为治疗新生儿严重IVH的安全有效方法,可有效防止脑积水的发生发展。

Abstract:

OBJECTIVE: Hydrocephalus is one of the most common complications of neonatal intraventricular hemorrhage (IVH). In this study, the effect of serial lumbar puncture (LP) on severe neonatal IVH is evaluated. METHODS: The effects of serial LP on 30 neonates hospitalized with severe IVH at Xinhua hospital since 1993 was evaluated. Another 30 neonates with severe IVH who had not been treated for preventing post-IVH hydrocephalus were used as the control group. RESULTS: Of the 30 cases which received serial LP therapy, the cerebral ventricles of 25 cases stopped enlarging and shrank distinctly. The effective rate was 83.3% . The average age when serial LP therapy initiated was (15.0 ±13.5) days, the average treatment course was (16.9 ±12.9) days. The serial LP therapy was repeated (6.4±4.7) times. The avarage interval of LP was (2.9 ± 2.7) days and the average CSF volume removed was (6.7±1.6) ml. The average time of LP taking effect was (9.6 ± 5.5) days. Ten cases received diamox treatment during the course of serial LP. After 1 - 2 weeks' combined treatment, the enlarged ventricles of 8 cases returned to normal or remained steady. Eighteen of 25 ases were followed-up for (8.3±1.9) months. Their physical and mental development were normal. Cranialcerebral ultrasound examination found that the shapes of cerebral ventricles of 14 cases were normal and the cerebral ventricles of another 4 cases enlarged slightly. The treatment with removed CSF > 5 ml/ time or with a shorter interval of LP ( < 2 d) acheived better effect ( P < 0. 05 or 0. 01) . In the control group, the cerebral ventricles of 23 cases enlarged moderately or severely (6 of them complicated with hydrocephalus). CONCLUSIONS: Serial LP is a safe and effective method for severe neonatal IVH in preventing post-IVH hydrocephalus.