CT检查对新生儿缺氧缺血性脑病预后判断的价值

目的　探讨CT检查对判断新生儿缺氧缺血性脑病 (HIE)预后的价值。方法　对 85例HIE患儿分别在生后 1周内、2周～ 2个月、3～ 6个月、1～ 1 5岁进行CT检查 ;同时在生后12～ 14d进行新生儿行为神经测定 ;在 1～ 1 5岁测定发育商判断预后。结果　生后 1周内CT结果分度为重度者预后不良率为 4 0 9% (9/ 2 2 ) ,为中度者预后不良率为 5 7% (3/ 5 2 ) ;2个月时CT随访结果异常者预后不良率为 6 0 0 % (6 / 10 ) ;CT结果中度且 12～ 14d的NBNA评分≥ 35分与 <35分者的预后差异无显著性 ,CT结果重度且 12～ 14d的NBNA评分 <35分者有 72 7% (8/ 11)预后不良。结论　生后 1周内CT分度及生后 1个月左右随访结果 ,同时结合临床、生后 12～ 14dNBNA评分对判断HIE患儿的预后、制定治疗方案及疗程有重要意义。

Use of computed tomography in evaluating prognosis for infants with hypoxic ischemic encepholopathy

Objective To study computed tomography (CT) in evaluating prognosis for hypoxic ischemic encephalopathy (HIE) in infants. Methods Eighty-five infants diagnosed as HIE underwent CT one week,two months,three to six months and one to one and a half years after birth,respectively. At the same time,neonatal behavior neurological assessment (NBNA) was made at 12 to 14 days after birth. Development quotient (DQ) was used to evaluate their prognosis at age of 1 to 1.5 years. Results Rate of poor prognosis was 40.9% (9/22) in the infants with severe HIE by CT and 5.7% (3/52) in those with moderate HIE within one week after birth. Rate of poor prognosis was 60.0% in the infants with abnormal CT at age of two months. There was no significant difference in their prognosis for infants of moderate HIE with NBNA scores greater than or equal to 35 and less than 35,12 to 14 days after birth. And,72.7% (8/11) of the infants with severe HIE by CT with NBNA less than 35 showed little recovery at 12th-14th days after birth. Conclusions Combination of CT and clinical follow-up with NBNA score one month after birth could play an important role in the evaluation for therapy regime,length of treatment and prognosis in the infants with HIE.