新生儿自发性颅内出血的诊治要点及对心理、智力发育的影响
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摘要
目的探讨新生儿自发性颅内出血的诊断方法、临床特点与治疗方法,并观察其心理与智力发育的情况。方法选取2013年6月-2016年6月,广州市妇女儿童医疗中心收治的60例临床资料完整的新生儿自发性颅内出血患者进行回顾性分析,并比较其与正常新生儿的智能发育指数(MDI)与心理智力发育状况。结果 6例患儿诊断为先天性维生素K缺乏症,46例诊断为脑动静脉畸形,2例诊断为海绵状血管瘤,4例诊断为后交通动脉瘤,3例诊断为烟雾病,另有1例原因不明。经过治疗,48例痊愈,7例轻残,3例中残,2例死亡。随访至12个月,自发性颅内出血新生儿MDI指数与发育商均低于正常新生儿,差异有统计学意义(P<0.05)。结论新生儿颅内出血可导致其心理与智能发育不良,而凝血功能、DSA、CT、MRI对其诊断有重要意义,医生应根据情况选取合适治疗方法,尽早诊治。
Objective To explore the clinical features and treatment options of spontaneous intracranial hemorrhage in neonates and the effect of intelligence and psychological development. Methods The medical records and radiographic images of 60 neonates who were spontaneous intracranial hemorrhage and treated in our hospital from June 2013 to June 2016 were retrospectively analyzed,and their Mental development index(MDI) and psychological development were compared with normal neonates. Results 6 neonates were diagnosed with Vatime K deficiency,46 cases were diagnosed as cerebral arteriovenous malformation,2 cases were diagnosed as cavernous hemangioma,4 cases were diagnosed as posterior communicating artery aneurysm and 3 cases were diagnosed as moyamoya.After treating,48 cases were healed,10 cases were disabled and 2 cases were dead. The MDI and developmental quotient in neonates with spontaneous intracranial hemorrhage were lower than normal neonate after 12 months follow-up. Conclusions Neonatal intracranial hemorrhage can impact intelligence and psychological development. Blood coagulation,DSA,CT and MRI made great contribution for diagnosis,the clinician should take appropriate treatment options according to different causes of disease.
Objective To explore the clinical features and treatment options of spontaneous intracranial hemorrhage in neonates and the effect of intelligence and psychological development. Methods The medical records and radiographic images of 60 neonates who were spontaneous intracranial hemorrhage and treated in our hospital from June 2013 to June 2016 were retrospectively analyzed,and their Mental development index(MDI) and psychological development were compared with normal neonates. Results 6 neonates were diagnosed with Vatime K deficiency,46 cases were diagnosed as cerebral arteriovenous malformation,2 cases were diagnosed as cavernous hemangioma,4 cases were diagnosed as posterior communicating artery aneurysm and 3 cases were diagnosed as moyamoya.After treating,48 cases were healed,10 cases were disabled and 2 cases were dead. The MDI and developmental quotient in neonates with spontaneous intracranial hemorrhage were lower than normal neonate after 12 months follow-up. Conclusions Neonatal intracranial hemorrhage can impact intelligence and psychological development. Blood coagulation,DSA,CT and MRI made great contribution for diagnosis,the clinician should take appropriate treatment options according to different causes of disease.
引文
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[12]吴雅娟,吕庆鹏,何志萍,等.促进早产低体重儿智能及心理发育的综合干预[J].国际精神病学杂志,2015,42(3):42-45.
[2]范存任.婴幼儿智能发育测验手册[M].北京:团结出版社,1998:138-164.
[3]欧萍,卢国斌,张冰凌,等.小儿神经心理发育预警征象应用效果评价[J].中国妇幼保健,2014,29(3):366-370.
[4]Pavlov AN,Semyachkina-Glushkovskaya OV,Zhang Y,et al.Multiresolution analysis of pathological changes in cerebral venous dynamics in newborn mice with intracranial hemorrhage:adrenorelated vasorelaxation[J].Physiological Measurement,2014,35(10):1983-1999.
[5]Paridaans NP,Kamphuis MM,Taune Wikman A,et al.Low-Dose versus Standard-Dose Intravenous Immunoglobulin to Prevent Fetal Intracranial Hemorrhage in Fetal and Neonatal Alloimmune Thrombocytopenia:A Randomized Trial[J].Fetal Diagnosis&Therapy,2015,38(2):147-153.
[6]冯绍连,李景新.神经节苷脂钠治疗新生儿自发性颅内出血的临床观察[J].北方药学,2016,13(7):19-20.
[7]Ben A S,Tiss O,Sfaihi L,et al.Severe haemophilia B revealed by intracranial hemorrhage in a newborn[J].La Tunisie Médicale,2015,93(5):330-331.
[8]胡春霞,李跃萍,华少萍,等.470例早产相关因素及早产儿结局分析[J].中国妇幼保健,2013,28(18):2914-2916.
[9]Liang F,Ding J,Zhou H E,et al.Application of cranial B ultrasound and MRI in diagnosis of intracranial hemorrhage of the newborn[J].Chinese Journal of Modern Drug Application,2015,6(9):3-21.
[10]Alexander MD,Cooke DL,Nelson J,et al.Association between Venous Angioarchitectural Features of Sporadic Brain Arteriovenous Malformations and Intracranial Hemorrhage[J].American Journal of Neuroradiology,2015,36(5):43-69.
[11]蔡琳,黄咏梅.新生儿自发性颅内出血治疗体会(附8例分析)[J].海南医学,2004,15(2):43.
[12]吴雅娟,吕庆鹏,何志萍,等.促进早产低体重儿智能及心理发育的综合干预[J].国际精神病学杂志,2015,42(3):42-45.