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MRI征像分析在新生儿缺氧缺血性脑损伤诊断中的临床价值

作者:马 菲 张欣贤 刘畅畅

所属单位:徐州医科大学附属医院医学影像科(江苏 徐州 221000)

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摘要

目的 探讨MRI征像分析在新生儿 缺氧缺血性脑损伤诊断中的临床价值。方 法 回顾性分析2013年2月至2015年5月在 我院新生儿科住院的711例缺氧缺血性脑 损伤新生儿MRI资料。结果 新生儿缺氧 缺血性脑损伤主要发生于产前、产时及 产后不同时期,本组711例新生儿中,产 前及产时窒息有583例,产后为128例; 682例患儿头颅MRI证实脑损伤(95.92%, 682/711),最常见的类型为白质损伤 (590/711,82.98%),其次为灰质损伤, 包括皮层损伤(369/711,51.89%),基底 节-丘脑损伤(298/711,41.91%)及脑干损 伤(263/711,36.99%);不同程度损伤的 轻度组、中度组、重度组之间间1 min、5 min Apgar 评分差异均有统计学意义(P﹤ 0.05)。结论 新生儿缺氧缺血性脑损伤最 常见的类型为白质损伤,中、重度脑病患 儿的MRI影像学损伤程度较重,且以基底 节-丘脑损伤为主。MRI影像分析对新生儿 缺氧缺血性脑损伤诊断尤为重要。

Objective To investigate the clinical value of MRI in diagnosis of neonatal hypoxic ischemic brain damage. Methods MRI data of 711 cases of neonatal hypoxic ischemic brain injury in our hospital from May 2015 to February 2013 were retrospectively analyzed. Results Neonatal hypoxic ischemic brain damage occurs mainly in different periods of prenatal, birth and postpartum period, In this group of 711 cases, there were 583 cases of asphyxia during birth and birth, 128 cases after birth, 682 cases of brain injury (95.92%, 682/711),The most common type was white matter damage (590/711, 82.98%), followed by gray matter damage, including cortical damage (369/711, 51.89%),Basal ganglia thalamic injury (298/711, 41.91%) and brain stem damage (263/711, 36.99%);There were statistically significant differences in the scores of 1 min and 5 Apgar (P<0.05) in mild and moderate and severe groups with different degrees of injury. Conclusion The most common type of neonatal hypoxic ischemic brain damage is white matter damage, and the MRI imaging of the patients with moderate and severe brain injury is more serious, and the basal ganglia and thalamus damage is the most important. MRI image analysis is very important for the diagnosis of neonatal hypoxic ischemic brain damage.

【关键词】MRI;新生儿;缺氧缺血性脑 损伤;诊断特征

【中图分类号】R651.1+5

【文献标识码】A

【DOI】 10.3969/j.issn.1672- 5131.2016.02.007

前言

新生儿缺氧缺血性脑病(Hypoxic-ischemic brain injury,HIBI) 是各种原因引起新生儿脑组织缺血缺氧导致的脑部病变,预后多不 佳,是新生儿死亡或致残的主要原因[1]。HIBI的早期诊断对治疗及预 后极其重要,目前CT、B超已广泛应用于HIBI的研究, 提高了人们对 HIBI发病过程有进一步的认识。研究表明,通过MRI检查能够清楚观察 到脑部病变发生情况,特别是对脑实质、基底节区出血、脑室周围白 质损伤及特殊脑损伤[2]。鉴于此,本文对HIBI患儿进行MRI扫描检查, 探讨HIBI脑损伤类型, 以指导治疗及判断预后。现将结果报道如下。