床旁超声诊断早产儿脑室周围-脑室内出血的价值

Value of bedside ultrasonography in diagnosis of periventricular-intraventricular hemorrhage in premature infants

  • 摘要: 目的 分析床旁超声诊断早产儿脑室周围-脑室内出血(PIVH)的价值。 方法 回顾性分析180例行床旁超声诊断的早产儿的临床资料,从矢状切面、冠状切面及经颞窗横切面连续扫描检查,观察所有早产儿的颅内病变,并依据Papile分级法对早产儿的出血程度进行分级。比较大脑动脉血流参数[大脑中动脉峰值流速(Vs)、舒张期流速(Vd)以及大脑中动脉阻力指数(RI)]时,将10例首次经床旁超声诊断无异常但复查后发生PIVH的患儿设为对照组,另抽取10例发生PIVH早产儿为PIVH组进行比较。 结果 180例早产儿均接受床旁超声检查,发生PIVH的患儿41例,发生率为22.78%。Papile Ⅰ级患儿36例(87.80%), Ⅱ级患儿3例(7.32%), Ⅲ级患儿2例(4.88%)。PIVH组VsVd显著低于对照组, RI显著高于对照组(P<0.05)。胎龄≥32周的早产儿PIVH发生率显著高于胎龄<32周的早产儿(P=0.001)。出生体质量<1.5 kg的早产儿PIVH发生率显著高于出生体质量≥1.5 kg的早产儿(P=0.001)。 结论 床旁超声诊断能够定位PIVH早产儿的出血部位,监测早产儿颅内出血的变化,具有一定的临床诊断价值。

     

    Abstract: Objective To analyze the value of bedside ultrasonography in diagnosis of periventricular-intraventricular hemorrhage(PIVH)in premature infants. Methods The clinical data of 180 premature infants undergoing bedside ultrasonography was retrospectively analyzed. The continuous scanning in sagittal section, coronal section and transtemporal window cross-section was performed for all premature infants by bedside ultrasound. The intracranial lesions of all premature infants were observed, and the Papile Grading method was used to classify their degree of bleeding. A total of 10 premature infants without abnormalities firstly diagnosed by bedside ultrasound but were confirmed as PIVH after re-examination were included in control group, and another 10 premature infants with PIVH were selected as PIVH group, and cerebral arterial blood flow parameters[systolic peak velocity(Vs), diastolic peak velocity(Vd)and cerebral artery resistance index(RI)] of two groups were compared. Results A total of 180 premature infants all underwent bedside ultrasonography, among whom 41 patients developed PIVH including 36(87.80%)cases with Papile Ⅰ grading, 3(7.32%)with Papile Ⅱ grading, and 2(4.88%)cases with Papile Ⅲ grading, with the total incidence of 22.78%. The Vs and Vd in the PIVH group were significantly lower, and RI was significantly higher than those in the control group(P<0.05). The incidence rates of PIVH in premature infants with gestational age ≥32 weeks(P=0.001)and in those with birth weight <1.5 kg(P=0.001)were significantly higher than those with gestational age<32 weeks and birth weight ≥1.5 kg. Conclusion Bedside ultrasound can - locate the bleeding sites in premature infants with PIVH, and monitor the changes of intracranial hemorrhage, which provides diagnostic value for PIVH in premature infants.

     

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