Early diagnosis of neonatal cerebral infarction

目的 探讨早期诊断新生儿脑梗死(NCI)的相对可行的方法.方法 有目的 地收集在我院分娩的NCI高危儿和同顾分析转诊患儿的围产期病史;记录发病或确诊前后患儿临床表现;比较颅脑超声、CT及MRI三种影像学检查对NCI诊断的敏感性及各自特点并分析NCI发病高危因素、临床和影像学特点.结果 (1)与NCI相关的高危因素包括:母亲妊娠期高血压疾病和宫内感染、各种原因所致胎儿窘迫和(或)生后窒息、脑血管发育畸形和新生儿红细胞增多症等.(2)主要临床表现:55.3%(21/38)出现惊厥.其中57.1%(12/21)为与病灶部位相吻合的局灶性惊厥.23.7%(9/38)未出现惊厥,而有不同程度意识改变、肌张力异常和(或)原始反射异常等非特异性神经系统表现.21.1%(8/38)患儿没有显著临床表现.(3)发病后2～3 d内颅脑超声检查的阳性率达85.0%～90.9%,MRI的阳性率为(5/7～9/9),均高于CT的阳性率(2/4～5/9)(P=0.043).三种方法对晚期脑梗死病灶均能有效地做出诊断,阳性率分别为:颅脑超声94.7%、头颅CT 93.8 %,MRI为100%,差异没有统计学意义(P=0.59).结论 MRI尤其是弥散加权MRI和颅脑超声均能对NCI做出早期诊断;早期诊断的程序包括:关注具有高危围产因素的新生儿;生后密切观察神经系统的症状和体征、并给予常规颅脑超声筛查;必要时进行MRI确诊.Objective To investigate feasible measures for early diagnosis of neonatal cerebral infarction (NCI).Methods Retrospective study was conducted on high risk NCI infants born in our hospital.By analyzing the perinatal history and symptoms of these infants before and after the final diagnosis,the characteristics of three methods (ultrasounds,CT and MRI) and their sensitivity in diagnosing NCI were compared.Results (1) Risk factors related to NCI included hypertensive disease complicated pregnancy,intrauterine infection,fetal distress,asphyxia of newborn,arterial malformation,neonatal polycythemia,etc.(2) Twenty-one of the 38 identified infants(55.3%) developed convulsion,among which 12 infants presented with partial seizure consistent with the injured location.Nine infants(23.7%) had no seizures,but with some nonspecific neural manifestations in different levels,such as consciousness disorder,dystonia,or abnormal original reflection.Eight infants(21.1%) had no obvious symptoms.(3)The positive rate in detecting NCI,2-3 days after clinical onset,was 85.0%-90.9% through cranial ultrasound,higher than that of CT (2/4-5/9)(P=0.043).All of the three methods were effective in diagnosing advanced NCI.Conclusions The early diagnosis of NCI can be made by MRI (DW-MRI) and cranial ultrasound.Full concern should be given to the high risk infants with closely monitoring of their neural symptoms and signs.Routine cranial ultrasound screening is necessary and MRI may be required to confirm the dignosis.首都医学发展基金联合攻关项目中国科技核心期刊(ISTIC)04281-2841