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目的对早产儿重度脑室内出血早期连续腰穿(LP)疗效的评估。方法对45例出生后经床边头颅B超诊断为重度脑室内出血的早产儿分为LP治疗组和常规治疗组。常规治疗组入选24例;LP治疗组为在常规治疗基础上进行了连续LP治疗,入选21例,开始LP治疗的平均日龄为(9.8±4.2)d(3～11d),LP间隔天数为(2.5±2.2)d(1～6d),每次LP放液量为(7.1±2.8)ml(2.5～10ml),LP次数为(7.1±5.2)次(5～26次),LP疗程为(15.6±19.3)d(6～52d),LP起效天数为(9.4±4.1)d,(7～19d)。CSF蛋白治疗前为(1.97±0.56)g/L,CSF蛋白治疗后为(0.72±0.33)g/L,全部恢复正常,差别有高度显著性(P<0.01)。结果经连续LP治疗后,脑室完全恢复至正常11例,脑室稍大,但形态持续保持稳定5例,成功率76.2(16/21),导致脑积水的不良预后率23.8(5/21)。对照组24例重度IVH早产儿均未进行LP治疗,18例发展为脑积水。在早产儿出生10个月的到访复查19例中,11例呈脑积水,8例轻度脑室扩大,形态保持稳定。未经连续LP治疗的重度IVH患儿发生不良预后率57.9(11/19),未发生脑积水的42.1(8/19)。结论连续LP治疗早产儿IVH后脑积水、改善预后有显著疗效。
Objective To evaluate the effect of early continuous lumbar puncture (LP) on severe intraventricular hemorrhage in premature infants. Methods 45 cases of preterm infants diagnosed with severe intracerebral hemorrhage after bedside cranial ultrasound B were divided into LP treatment group and conventional treatment group. The routine treatment group was enrolled in 24 cases. In the LP group, continuous LP treatment was performed on the basis of routine treatment. Among the 21 cases, the mean age at the beginning of LP treatment was (9.8 ± 4.2) days (3 to 11 days) (2.5 ± 2.2) d (1 ~ 6d). The volume of LP excretion was (7.1 ± 2.8) ml (2.5 ~ 10ml) each time and the number of LP was (7.1 ± 5.2) (15.6 ± 19.3) days (6 ~ 52 days), and the number of days of LP onset was (9.4 ± 4.1) days (7-19 days). CSF protein was (1.97 ± 0.56) g / L before treatment and (0.72 ± 0.33) g / L after CSF protein treatment, all of which returned to normal, the difference was highly significant (P <0.01). Results After continuous LP treatment, ventricles were completely recovered to normal in 11 cases and ventricles were slightly larger, but the morphology remained stable in 5 cases with a success rate of 76.2 (16/21), leading to a poor prognosis rate of 23.8 (5/21) . Control group, 24 cases of severe IVH premature children were not treated with LP, 18 cases of hydrocephalus. Of the 19 patients who were surveyed during their 10-month preterm birth, hydrocephalus was found in 11 patients and enlarged ventricles in 8 patients. The morphology remained stable. The incidence of adverse outcomes was 57.9 (11/19) in non-consecutive LP-treated children with severe IVH and 42.1 (8/19) in those without hydrocephalus. Conclusion Continuous LP treatment of premature infants with IVH after hydrocephalus and improve the prognosis of a significant effect.