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    顱腦超聲在診斷新生兒顱腦疾病中的應用
    關鍵字:應用,疾病,診斷,op,mn,qr,st,uv,kl,ij, 發布時間:2011-08-19

    420 第28卷第4期 2010年8月 廣東醫學院學報 JOURNALOFGUANGDONGMEDICALCOLLEGE 、7_01.28No.4 Aug.2010 降,但趨于穩定且易于控制;大多數患者的高血糖經過綜合 治療后,血糖可以得到控制。但是對于少數重型和特重型顱 腦損傷患者,高血糖往往持久且較難控制,這些患者的預后 也比較差。血糖控制的難易也是患者預后的一個信號。 參考文獻: 【l】WaliaS,SuteliffeAJ.Therelationshipbetweenbloodglucosemean arterialpressureandoutcomeaftersevereheadinjuryandobserva- tionalstudy[J].珂ury,2002,33(4):339-344. 【2】1eremitskyE,OmertL氣DunhamCM,etal.Theimpacthypergly- cemiaonpatientswith84evcrfbraininjary[J].JTraum,2005,58(1): 47.50. 【3】ZyganDA,SteinerLA,JohnstonAJ,etal.Hyperglycemiaandbrain tissuepHafterWaumaticbraininjury[J】.Nearosury,2004,55(4): 877—881. 【4】何朝暉,支興剛,唐文淵,等.大鼠腦損傷后胰島索抵抗與傷后高血 糖的相關分析【J】.南方醫科大學學報,2007,27(3):315.317. 【5】VanbeekJG,MushkudianiNA,SteyerbergEW.eta1.Prognostic valueofadmissionlaboratoryparametersintraunbraininjury:results fromtheimpactstudy【J】.JNeurotma,2007,24(2):315-328. 【6】蹦D,ZhangS,LinX.Study ontherapeuticmethodandclinical effectofmiMhypothermiainpatientswithheadi巧ury【J】.Surg Neural,2003,59(5):381-385. 【7】馬越,劉敬業,張楷文.重型顱腦損傷后胰島素受體的變化【J】.天津 醫藥,2007,35(6):452-453. 顱腦超聲在診斷新生兒顱腦疾病中的應用 黃穎,程小穗,蔡艷,許楊明 (廣東省湛江中心人民醫院超聲影像科,廣東湛江524037) 摘要:目的探討顱腦超聲在新生兒顱腦疾病中的診斷意義。方法對生后出現窒息或不同程度神經系統癥狀的 102例高危新生兒進行顱腦超聲檢查。結果102例中,通過顱腦超聲診斷新生兒缺血缺氧性腦病42例,腦內出血23例, 腦室周圍白質軟化4例,腦室擴張8例,化膿性腦膜炎l例。顱腦超聲對新生兒顱腦疾病的陽性診斷率為76.5%。結論顱 腦超聲可對新生兒顱腦疾病作動態觀察,且有快速方便、無放射損傷、可反復應用及廉價等優點,可為新生兒顱腦疾病 的早期診斷、指導治療及預后評價提供有價值的影像學依據。 關鍵詞:新生JL;顱腦損傷;超聲診斷 中圖分類號:R445.I文獻標識碼:B文章編號:1005-4057(20LO)04.0420-02 DOI:10.39690js姐.1005-4057.2010.04.034 新生兒顱內疾病是神經系統后遺癥產生的原因之一,對 于患兒預后有重要影響。顱腦超聲診斷因其具有獨特優點, 在新生兒領域迅速普及,已成為新生兒、嬰兒顱腦病變的主要 影像診斷方法之一。本文通過x寸i02例高危新生兒進行顱腦超 聲檢查,進一步評價超聲在新生兒顱腦疾病中的應用意義。 1資料和方法 1.1一般資料 在2009年1月至2010年1月間,在我院新生兒科住院、出 生后有窒息或不同程度的神經系統癥狀的高危新生兒并行顱 腦超聲檢查共102例,其中男56例,女46例,患兒宮內胎齡為 28-..42周,出生體重0.8.06.0kg;低體重JL46例,圍產期缺氧 或產后窒息24例,產后伴神經系統癥狀者16例,宮內感染者 6例,孕婦妊娠高血壓者lo例。 1.2方法 儀器采用西門子公司生產的ACUSON¥2000超聲診斷儀, 專用變頻探頭10V4。在6一10Mhz條件下冠狀位和矢狀位掃 描檢查。觀察患兒雙側大腦半球和整個腦實質回聲結構、透 收稿日期:2010.03.16;修訂日期:2010.06.10 作者簡介:黃穎(1975一)。女,本科,主治醫師。 明隔腔大小,測量雙側側腦室前角寬度、雙側脈絡叢寬度。 2 結果 42例,腦內出血23例(其中室管膜下出血17例),腦室擴 張8例,腦室周圍白質軟化(PVL)4例(圖1),化膿性腦膜炎1例。 2.1新生兒缺血缺氧性腦病餌固 共42例,超聲表現為:(1)局灶型25例(59.5%),側腦室 周圍和丘腦彌漫性腦組織回聲增強、模糊,可見散在點狀或 斑片狀強回聲。(2)腦水腫型9例(21.4%),腦實質回聲增強, 腦室變窄或消失。(3)腦室旁白質軟化型5例(11.9%),腦室周 圍高回聲區,多見于側腦室前角底后方。(4)丘腦及基底神經 節損傷型3(7.1%),丘腦、基底神經節部位呈雙側對稱性回聲 增強區。 2.2顱內出血 共23例,其中室管膜下出血17例,腦室內出血4例,腦 實質出l例,脈絡叢出血1例。 2.2.1窒管膜下出血聲像圖改變為冠狀切面相當于側腦室前 角外下方,有局灶性的強回聲光團,矢狀切面檢查可發現丘 腦尾狀核溝處回聲增強(圖2)。 2.2.2腦室內出血聲像圖為患側腦室內可見不同形狀的強 回聲團(圖3),可合并腦室擴大。少量出血時,可局限于某一 萬方數據 換頁 第4期黃穎,等.顱腦超聲在診斷新生兒顱腦疾病中的應用421 區域,大量出血時則整個腦室內出現均勻一致的強回聲。脈 絡叢出血主要表現為患側脈絡叢比健側脈絡叢增大并形態不 規整。 2.2.2腦實質出血主要表現為腦實質內不同部位可出現強回 聲,形態大小不一,因出血量多少而異。腦實質內大的出血 可引起腦中線偏移同側側腦室受壓變形。如血塊吸收后,可 出現無回聲的空洞。 田1腦室周圍白質軟化圈2窒管膜下出血灶 圈3腦室內出血 2.3腦室擴張 共8例。新生兒側腦室在冠狀斷面上呈狹窄的羊角形或 裂隙狀,尖端呈銳角。如果第三腦室斷面呈圓形,表示已有 腦室擴大。本文中8例腦室擴張者,其中先天畸形2例,其腦 室擴張程度最嚴重,腦室內出血并腦室擴張者2例,化膿性腦 膜炎并腦室擴張者l例,重度HIE并腦室擴張者3例。 2.4化膿性腦膜炎 l例。超聲圖特點表現為腦溝腦回回聲增強,側腦室邊 界增厚,回聲增強,腦室內無回聲或回聲不均,甚至出現絮 狀物。常有側腦室不同程度的擴大,前角擴張,變鈍,失去 銳利的前角,重者丘腦、尾狀核及腦組織有受壓表現。 3討論 PvL早期臨床常無癥狀,頭顱超聲主要表現為腦室周圍 白質增強。診斷標準:I度,腦室周圍白質回聲增強,但是比 脈絡叢回聲稍弱;Ⅱ度。腦室周圍白質回聲強度與脈絡叢相 同,且僅限于側腦室三角部;11I度,腦室周圍白質回聲強度 比脈絡叢回聲強度增強,范圍超過側腦室角部【l】o隨著病情 發展。到2。3周出現尖端指向腦室方向的楔形囊狀無回聲 區,此時提示腦白質軟化。 顱內出血是新生兒尤其是34周以下未成熟兒致死或致殘 的最主要原因。早期發現和診斷新生兒顱內出血是兒科醫生 極為關注的問題。超聲檢查的優點是對腦室系統擴張的診斷 可以數量化。便于自身前后比較,且可實時觀察病灶形態、 部位、大小及與周圍組織的關系,高頻超聲診斷新生兒顱內 出血的準確性和特異性堪比x線CT,特別是對于室管膜下出 血和腦室內出血,但超聲對硬膜下腔、蛛網膜下腔和顱腦邊 緣及幕下部位的病變不敏感【2J。 腦膜炎是由于化膿性分泌物沉積于腦溝所致,其超聲改 變的主要特征為腦室擴大和腦膜回聲增強等,但必須結合臨 床方能做出診斷。 胎兒腦室擴張是指腦脊液過多地集聚于側腦室系統內。 致使側腦室在腦組織的發育過程中表現為擴張狀態。新生兒 側腦室在冠狀斷面上呈狹窄的羊角形或裂隙狀,尖端呈銳 角。正常側腦室比率LVR為(0.33±0.03)。新生兒第三腦室 呈窄的裂隙狀,約l一3tDJEt,平均(1.8±0.8)mm,有時僅隱 約可見,視儀器分辨力而定,如果第三腦室斷面呈圓形,表 示已有腦室擴大【31。腦室寬度測值與年齡增長有關。新生兒 腦室擴張的主要病因為先天畸形、產傷性顱內出血、 TORCH綜合征、化膿性腦膜炎、HIE和早產兒室內出血等。 早產兒尤其胎齡在23~34周的早產兒最易發生PVL,低胎 齡和低體重均是PVL發病的危險因素。缺血缺氧性腦病是導 致嬰幼兒和兒童神經系統及發育缺陷的主要原因。在未成熟 發育的早產兒中,缺血缺氧性腦病的主要表現還包括腦室旁 白質軟化和腦室旁出血性梗死。PVL是早產幾HIE損傷的特 殊形式,早期超聲征像為雙側腦室周圍的強回聲條片影。 此外缺血缺氧性腦病的表現還包括腦水腫、皮質部梗死 等。新生兒腦室擴張多由于腦室內出血或顱內干擾所致,腦 室增大早期.首先表現為側腦室前角加寬變圓,側腦室向外延 伸。因此測量腦室寬度是診斷早期腦室增大較敏感的指標【4】o Hm早期主要表現為在腦病周圍呈彌漫性均勻分布的輕度回 聲增強,腦室、腦溝及半球裂隙變窄或消失,并腦動脈搏動 減弱【510 綜上所述。顱腦超聲可動態了解顱腦出血的部位、范圍、 大小及回聲的演變,同時顱腦超聲還有準確、快速、方便、無 放射損傷、可反復應用及廉價等優點,為新生兒顱腦疾病的早 期診斷、指導治療及評價預后提供了有價值的影像學依據。 參考文獻: 【l】1武曉靜,王燕.超聲在新生兒顱腦疾病診斷中的應用進展m.河北醫 科大學學報,2008,290):474-477. 【2】武曉靜,王燕.超聲在新生兒顱腦疾病診斷中的應用【J】.河北醫科大 學學報,2008,29(2):260.262. 【3]葛暉,丁中,韓曼,等.新生兒顱腦疾病床邊超聲的診斷價值陰.蚌埠 醫學院學報,2009,34(7):628-630. 【4]王東軒,武輝,朱丹.超聲在新生兒顱腦疾病中的診斷價值【J】.中風與 神經疾病雜志,2006。23(6):699.701. 【5】劉敬,曹海英.新生兒損傷的超聲診斷與臨床【M】.北京:中國醫藥科 技出版社,2004:54-113. 萬方數據 換頁

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