中华围产医学杂志
中華圍產醫學雜誌
중화위산의학잡지
CHINESE JOURNAL OF PERINATAL MEDICINE
2014年
3期
173-179
,共7页
脑梗死%婴儿,新生%预后%危险因素
腦梗死%嬰兒,新生%預後%危險因素
뇌경사%영인,신생%예후%위험인소
Brain infarction%Infant,newborn%Prognosis%Risk factors
目的 总结新生儿脑梗死的预后及其危险因素. 方法 2002年1月至2010年12月,北京大学第一医院新生儿科经影像学检查共确诊新生儿脑梗死44例,通过神经系统临床表现、Gesell评分、头颅影像学检查、脑电图、视听诱发电位等神经系统检查综合评判患儿是否存在神经系统后遗症,并通过单因素及多因素Logistic回归分析影响新生儿脑梗死神经系统不良预后的危险因素. 结果 共随访到38例患儿,随访率为86％,其中5例患儿放弃治疗后死亡,病死率为13％(5/38).3例因随访年龄＜6个月尚无法判断后遗症情况,其余30例患儿有后遗症者15例,无后遗症者1 5例,后遗症的发生率为50％(15/30).1 5例遗留后遗症者均有运动障碍,合并癫痫8例,合并认知障碍8例,合并视觉障碍5例.有后遗症的新生儿脑梗死患儿脑损伤范围较大(梗死范围包括至少一个脑叶)、影像学结局差(治疗后至少1个月影像学显示脑梗死病灶扩大或持续存在)、存在严重合并症的比例分别为14/15、13/15和8/15,高于无后遗症组(分别为4/15、5/15和1/15),差异均有统计学意义(x2值分别为13.889、8.889和7.778,Jp值均＜0.05).多因素分析发现,损伤范围大与新生儿脑梗死遗留神经系统后遗症密切相关(OR=38.500,95％CI:3.749～395.407,P=0.002),而影像学结局差(OR=8.563,95％CI:0.909～80.683,P=0.061)和存在严重合并症(OR=18.024,95％CI:0.516～630.163,P=0.111)与遗留后遗症无关.损伤大脑中动脉主干者遗留运动障碍的可能性较大(OR=6.000,95％CI:1.172～3.725,P=0.025);损伤范围大者遗留癫痫的可能性较大(x2=7.273,P=0.010);遗留认知障碍者脑损伤范围大的比例为8/8,明显高于无认知障碍者(46％,10/22),脑损伤范围与遗留认知障碍有关(x2=7.273,P=0.010). 结论 新生儿脑梗死患儿存在多种神经系统后遗症,其中运动障碍最常见.新生儿脑梗死患儿脑损伤范围较大者遗留神经系统后遗症的可能性较大.
目的 總結新生兒腦梗死的預後及其危險因素. 方法 2002年1月至2010年12月,北京大學第一醫院新生兒科經影像學檢查共確診新生兒腦梗死44例,通過神經繫統臨床錶現、Gesell評分、頭顱影像學檢查、腦電圖、視聽誘髮電位等神經繫統檢查綜閤評判患兒是否存在神經繫統後遺癥,併通過單因素及多因素Logistic迴歸分析影響新生兒腦梗死神經繫統不良預後的危險因素. 結果 共隨訪到38例患兒,隨訪率為86％,其中5例患兒放棄治療後死亡,病死率為13％(5/38).3例因隨訪年齡＜6箇月尚無法判斷後遺癥情況,其餘30例患兒有後遺癥者15例,無後遺癥者1 5例,後遺癥的髮生率為50％(15/30).1 5例遺留後遺癥者均有運動障礙,閤併癲癇8例,閤併認知障礙8例,閤併視覺障礙5例.有後遺癥的新生兒腦梗死患兒腦損傷範圍較大(梗死範圍包括至少一箇腦葉)、影像學結跼差(治療後至少1箇月影像學顯示腦梗死病竈擴大或持續存在)、存在嚴重閤併癥的比例分彆為14/15、13/15和8/15,高于無後遺癥組(分彆為4/15、5/15和1/15),差異均有統計學意義(x2值分彆為13.889、8.889和7.778,Jp值均＜0.05).多因素分析髮現,損傷範圍大與新生兒腦梗死遺留神經繫統後遺癥密切相關(OR=38.500,95％CI:3.749～395.407,P=0.002),而影像學結跼差(OR=8.563,95％CI:0.909～80.683,P=0.061)和存在嚴重閤併癥(OR=18.024,95％CI:0.516～630.163,P=0.111)與遺留後遺癥無關.損傷大腦中動脈主榦者遺留運動障礙的可能性較大(OR=6.000,95％CI:1.172～3.725,P=0.025);損傷範圍大者遺留癲癇的可能性較大(x2=7.273,P=0.010);遺留認知障礙者腦損傷範圍大的比例為8/8,明顯高于無認知障礙者(46％,10/22),腦損傷範圍與遺留認知障礙有關(x2=7.273,P=0.010). 結論 新生兒腦梗死患兒存在多種神經繫統後遺癥,其中運動障礙最常見.新生兒腦梗死患兒腦損傷範圍較大者遺留神經繫統後遺癥的可能性較大.
목적 총결신생인뇌경사적예후급기위험인소. 방법 2002년1월지2010년12월,북경대학제일의원신생인과경영상학검사공학진신생인뇌경사44례,통과신경계통림상표현、Gesell평분、두로영상학검사、뇌전도、시은유발전위등신경계통검사종합평판환인시부존재신경계통후유증,병통과단인소급다인소Logistic회귀분석영향신생인뇌경사신경계통불량예후적위험인소. 결과 공수방도38례환인,수방솔위86％,기중5례환인방기치료후사망,병사솔위13％(5/38).3례인수방년령＜6개월상무법판단후유증정황,기여30례환인유후유증자15례,무후유증자1 5례,후유증적발생솔위50％(15/30).1 5례유류후유증자균유운동장애,합병전간8례,합병인지장애8례,합병시각장애5례.유후유증적신생인뇌경사환인뇌손상범위교대(경사범위포괄지소일개뇌협)、영상학결국차(치료후지소1개월영상학현시뇌경사병조확대혹지속존재)、존재엄중합병증적비례분별위14/15、13/15화8/15,고우무후유증조(분별위4/15、5/15화1/15),차이균유통계학의의(x2치분별위13.889、8.889화7.778,Jp치균＜0.05).다인소분석발현,손상범위대여신생인뇌경사유류신경계통후유증밀절상관(OR=38.500,95％CI:3.749～395.407,P=0.002),이영상학결국차(OR=8.563,95％CI:0.909～80.683,P=0.061)화존재엄중합병증(OR=18.024,95％CI:0.516～630.163,P=0.111)여유류후유증무관.손상대뇌중동맥주간자유류운동장애적가능성교대(OR=6.000,95％CI:1.172～3.725,P=0.025);손상범위대자유류전간적가능성교대(x2=7.273,P=0.010);유류인지장애자뇌손상범위대적비례위8/8,명현고우무인지장애자(46％,10/22),뇌손상범위여유류인지장애유관(x2=7.273,P=0.010). 결론 신생인뇌경사환인존재다충신경계통후유증,기중운동장애최상견.신생인뇌경사환인뇌손상범위교대자유류신경계통후유증적가능성교대.
Objective To determine the prognosis and risk factors of neonatal cerebral infarction.Methods From January 2002 to December 2010,44 newborn infants were diagnosed with cerebral infarction by imaging examinations at Peking University First Hospital.The neurodevelopmental outcomes of these newborn infants were followed up and evaluated by clinical manifestations,Gesell development scale,cranial imaging,electroencephalogram and auditory evoked potential.Factors related to prognosis were analyzed with single and multi-factor Logistic regression analysis.Results Thirty-eight (86％) cases were followed up,and of these cases,five children died and the results of three were inconclusive due to small age (less than 6 months old).Among the remaining 30 children,neurodevelopmental outcome was normal in 15 cases and abnormal in the remaining 15 cases,thus,the incidence of sequelae was 50％ (15/30) and the mortality rate was 13％ (5/38).Of the 15 abnormal cases,all had cerebral palsy and movement retardation,eight cases had cognitive impairment,eight cases had epilepsy and five had visual impairment.The incidence of large cerebral infarction (more than one lobe) was 14/15,worse cranial imaging outcome (one month after treatment,cerebral infarction lesion still present or had expanded)was 13/15,and severe complications was 8/15 in the newborns with sequelae,which were higher than in those without sequelae (4/15,5/15 and 1/15,respectively) (x2=13.889,8.889 and 7.778,all P＜0.05).Logistic regression analysis showed that large cerebral infarction was a risk factor for sequelae (OR=38.500,95％C1:3.749-395.407,P=0.002),however,worse cranial imaging outcome (OR=8.563,95％CI:0.909-80.683,P=0.061) and severe complications (OR=18.024,95％CI:0.516-630.163,P=0.111) were not risk factors for sequelae.Cerebral infarction with middle cerebral artery injury had a high risk of movement retardation (OR=6.000,95％CI:1.172-3.725,P=0.025),and those with a large cerebral infarction were more likely to have epilepsy (x2=7.273,P=0.010).The incidence of large cerebral infarction in the newborn infants with cognitive impairment was 8/8,which was much higher than in those without cognitive impairment (46％,10/22),thus,infarct area may be related to cognitive ability (x2=7.273,P=0.010).Conclusions Neonatal cerebral infarction might result in many types of sequelae,with motor impairment being the most common form.A large cerebral infarction is more likely to result in abnormal neurodevelopmental outcome.
