磁共振成像对新生儿缺氧缺血性脑病预后的早期评估

value of magnetic resonance imaging in the early evaluation of prognosis for hypoxic-ischemic

摘要:

目的：了解足月新生儿缺氧缺血性脑病（HIE）的临床特点，探讨头颅磁共振成像对HIE预后的早期评估价值。方法：对近5年收治的348例足月新生儿HIE的临床资料进行回顾性分析，包括病史、临床表现、磁共振检查及随访结果等。结果：足月新生儿HIE占同期收治新生儿总数的8.25%，76.2%患儿由出生时窒息引起，其中轻度窒息占59.2%,重度窒息占40.8%。总的预后不良率为10.1%，其中重度脑病的预后不良率27.3%, 中度为10.0%, 轻度为1.5%。磁共振表现为弥漫性脑实质出血与脑梗死、基底节与内囊损伤、细胞毒性脑水肿时重度、中度、轻度脑病患儿的预后不良率分别是100%, 87.5%, 81.8%。结论：HIE仍是新生儿常见疾病，可导致死亡或遗留伤残；其中轻度窒息所占比例大，应引起重视。磁共振成像对预后具有早期判断价值，当出现弥漫性脑实质出血与脑梗死、基底节与内囊损伤、细胞毒性脑水肿时预后可能不良，尤其当两种或以上异常同时存在时。［中国当代儿科杂志，2007，9（5）：407-410］

Abstract:

OBJECTIVE: To understand the clinical characteristics of hypoxic-ischemic encephalopathy (HIE) in full-term infants and to explore the value of magnetic resonance imaging (MRI) for the early prediction of HIE prognosis. METHODS: The medical data, including histories, clinical manifestations, MRI findings and follow-up outcomes, of 348 full-term infants with HIE between January 2001 and December 2005 were retrospectively reviewed. RESULTS: HIE patients (348 cases) accounted for 8.25% of in-patients (4220 cases) over the five years. The etiology of HIE mainly attributed to birth asphyxia (76.2%), consisting of mild asphyxia (59.2%) and severe asphyxia (40.8%). A poor outcome was confirmed in 10.1% of these patients, including 27.3% in severe HIE, 10.0% in moderate HIE and 1.5% in mild HIE cases. All of patients whose MRI showed diffusion intraparenchymal hemorrhages and cerebral infarctions had poor outcomes. Fourteen (87.5%) out of the 16 cases with basal ganglia and thalamic or internal capsule injury and 9 (81.8%) out of the 11 cases with cytotoxic brain edema diagnosed by diffusion weighted imaging had poor outcomes. CONCLUSIONS: HIE is one of common diseases in newborn infants. The etiology of neonatal HIE mainly attributed to birth asphyxia, mild asphyxia accounting for a greater proportion. MRI findings can be helpful for the early prediction of HIE prognosis.