新生儿行为神经测定及脑CT在新生儿缺氧缺血性脑病预后评估中的价值

【作者】 张新华；

【导师】 秦桂秀； 张小莉；

【作者基本信息】 山西医科大学 ， 新生儿， 2005， 硕士

【摘要】 目的:探讨新生儿行为神经测定(NBNA)及头颅CT与新生儿缺氧缺血性脑病(HIE)的关系,以及对HIE预后的早期评估价值,使HIE诊断及预后评估更具科学性。 方法:选择经临床检查诊断为不同程度的足月HIE患儿72例,分别于入院4～10天,4周进行头颅CT检查,并于同期及入院2周进行NBNA评分,3月,6月进行DQ值测定。 采用SIEMENS欢星螺旋CT机,扫描层距8mm,层厚8mm,扫描时间为2秒,扫捕层数8～10层。 NBNA评分采用鲍氏“新尘儿行为神经测定20项评分标准”由接受过专门培训的医生进行。 结果:①生后4～10天CT分度与临床分度的一致性比较差异有显著性(P<0.05)。②轻、中、重度HIE患儿在不同日龄、不同程度NBNA评分差异均有显著性(P<0.05)。程度越重,NBNA评分越低,预后越差。③中、重度HIE患儿NBNA测定14d≤35分患儿组的DQ值低于14d>35分组,统计学分析差异有显著性(P<0.005)。④生后28天脑CT改变与预后关系密切。 结论:早期头颅CT分度与临床分度一致性差,故单凭早期头颅CT很难确定HIE的病情和预后。应用NBNA评分可判断HIE的病情轻重。动态NBNA及生后28天左右脑CT可作为HIE预后的早期评估依据,而生后14d的NBNA评分判断预后意义最大。更多还原

【Abstract】 PurposeTo study the relationship between HIE and NBNA and brain CT,and evaluate the value of NBNA and brain CT for HIE early prognosis assessment and make diagnosis and prognosis assessment of HIE more scientific. MethodsThe study involved 72 term neonates with HIE in varying degrees, who were diagnosed by clinical examinations. Brain CT examinations were carried out at the age of 4 days~ 10 days and 4 weeks respectively; NBNA were performed at the age of 4 days~10days, 2 weeks and 4weeks respectively.DQ tests were performed at the age of 3 months and 6 months.The type of CT is SOMATO SMILE SPIRAL CT. Scan thickness is 8mm, Scan space is 8mm, Scan time is 2 seconds and Scan image is 8~10 layers.NBNA was carried out by specially trained doctors based on the "Chinese Newborns Action Nerve Grade Method of 20 Items". Results1. There was significant difference on Consistency between early brain CT and clinical examination to assessment of HIE degree(p<0.05).2. There were significant differences on NBNA scores of HIE neonates at different days after birth and that of HIE neonates with different degree (p< 0.05). The higher HIE degree was, the lower NBNA score was and the worse prognosis was.3. DQ of the group which NBNA scores at the age of 14 days were less than 35 was lower than that of the other group which NBNA scores were more than 35.There were significant differences on NBNA scores between the two更多还原