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目的加强对新生儿惊厥发作形式的认识,分析其病因及其预后,为早期诊断和治疗提供依据。方法对近4 a本院新生儿病房收治的302例患儿作全面观察并列表记录,尤其注意新生儿呼吸节律的突然变化、局部怪异动作、肢体抽动等情况,对可疑者予以重点观察,确定惊厥形式,并行血常规、血钙、血糖及脑CT检查,部分患儿行脑电图、血培养检查。在患儿出院后(52±2)周行书面随访,对有问题者进一步在专科、门诊进行检查随访,包括脑电图、脑CT、盖泽尔发育检查及神经系统体检。结果发生惊厥新生儿52例,可分为5种发作类型,分别为轻微型28例、多灶性阵挛型8例、面肌阵挛型7例、局灶性阵挛型6例及全身性阵挛型3例。其惊厥原因有HIE 18例,颅内出血12例,低血钙6例,低血糖、败血症各4例,颅内感染2例,核黄疸、破伤风各1例,病因不明4例。后遗症发生率为18.18%,其中以智力低下(MR)占首位(9.89%)。结论新生儿惊厥病因复杂,发作类型多样,轻微型最多见,对阵发性呼吸节律紊乱、下颌抖动及面部怪异动作的新生儿应提高警惕,及早识别。后遗症与发作形式及病因相关密切。
Objective To strengthen understanding of the form of neonatal seizures and analyze its etiology and prognosis, providing evidence for early diagnosis and treatment. Methods A total of 302 children admitted to our newborn ward during the past 4 years were enrolled in the study and recorded in a comprehensive manner. In particular, sudden changes in neonatal respiratory rhythms, local weird movements and limb twitching were observed. The suspicious persons were mainly observed and identified Convulsions form, parallel blood, blood calcium, blood glucose and brain CT examination, some children underwent EEG, blood culture examination. Follow-up visits were performed at 52 ± 2 weeks after discharge from the hospital, and further examination was carried out in specialist and outpatient departments for those with problems, including EEG, brain CT, Gerszel developmental examination and neurological examination. Results Fifty-two newborns with convulsion were divided into five types of seizure: 28 cases of mild type, 8 cases of multifocal clonus, 7 cases of clonic polyneuritis, 6 cases of focal clonus, 3 cases of genitie type. The causes of convulsions were 18 cases of HIE, intracranial hemorrhage in 12 cases, hypocalcemia in 6 cases, hypoglycemia, sepsis in 4 cases, intracranial infection in 2 cases, nuclear jaundice, tetanus in 1 case, etiology in 4 cases. The incidence of sequelae was 18.18%, among which mental retardation (MR) was the highest (9.89%). Conclusions The etiology of neonatal seizures is complex, the types of seizures are diverse, the most common is mild, the newborns with paroxysmal respiratory rhythm disorders, jaundice jerks and facial weird motions should be vigilant and recognize early. Sequelae and the attack form and cause closely related.