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目的：探讨新生儿脑室内出血（ＩＶＨ）的发病机理、预后与ＣＴ分级的关系，评价其ＣＴ诊断及随访价值。方法： ６０例经ＣＴ诊断为ＩＶＨ患儿，早产儿１９例，足月儿４１例，生后１周内作首次头颅ＣＴ扫描，１个月后进行ＣＴ随访观察。结 果：ＣＴ表现为不同程度的ＩＶＨ，侧脑室内出血５９例，侧脑室及第三脑室内出血１例；室管膜下出血（ＳＥＨ）１８例，早产儿１２ 例；脉络丛出血２４例，足月儿１９例；侧脑室轻度扩大１１例，急性梗阻性脑积水４例；脑实质内出血（ＩＣＨ）１１ 例，硬膜下血肿 （ＳＤＨ）３例，蛛网膜下腔出血（ＳＡＨ）４９例，缺氧缺血性脑病（ＨＩＥ）４６例。根据有无侧脑室扩大及ＩＣＨ，将本组新生儿ＩＶＨ分 为３级：Ⅰ级单纯ＩＶＨ４５例；Ⅱ级ＩＶＨ伴侧脑室扩大１０例；Ⅲ级ＩＶＨ伴侧脑室扩大、ＩＣＨ５例。随访中，１９例出现后遗ＣＴ改 变：Ⅰ级５例，均为侧脑室轻度扩大；Ⅱ级９例，侧脑室轻度扩大５例，梗阻性脑积水４例；Ⅲ级５例，侧脑室轻度扩大１例， 梗阻性脑积水３例，脑萎缩３例，脑软化灶４例。结论：Ⅰ级ＩＶＨ预后良好；Ⅱ、Ⅲ级ＩＶＨ预后较差。因此头颅ＣＴ扫描在新 生儿ＩＶＨ诊断及预后判断方面有重要价值。
Objective: To explore the pathogenesis of neonatal intraventricular hemorrhage (IVH), the relationship between prognosis and CT grade, evaluate the CT diagnosis and follow-up value. Methods: Sixty children with IVH diagnosed by CT, 19 preterm infants and 41 full term infants were diagnosed by CT. The first CT scan was performed within 1 week after birth. CT was followed up one month later. Results: CT showed different degrees of IVH, 59 cases of lateral ventricular hemorrhage, 1 case of lateral and third ventricular hemorrhage; 18 cases of subependymal hemorrhage (SEH), 12 cases of premature neonates; 24 cases of choroid plexus hemorrhage, (N = 19), mild lateral enlargement in 11 cases, acute obstructive hydrocephalus in 4 cases, intracerebral hemorrhage (ICH) in 11, subdural hematoma (SDH) in 3 and subarachnoid hemorrhage (SAH) in 49 , Hypoxic-ischemic encephalopathy (HIE) in 46 cases. According to the presence or absence of lateral ventricle expansion and ICH, the group of newborn IVH is divided into three levels: Ⅰ grade simple IVH45 cases; Ⅱ grade IVH with lateral ventricle enlargement; Ⅲ grade IVH with lateral ventricle expansion, ICH5 cases. In the follow-up, 19 cases had posterior subsidence CT changes: 5 cases of grade Ⅰ were mild ventricular enlargement in 9 cases, 9 cases of grade Ⅱ, 5 cases of lateral ventricle slight enlargement, 4 cases of obstructive hydrocephalus, 5 cases of grade Ⅲ, One case of lateral ventricle was mildly enlarged, 3 cases of obstructive hydrocephalus, 3 cases of brain atrophy, 4 cases of cerebral softening. Conclusions: The prognosis of grade Ⅰ IVH is good. The prognosis of grade Ⅱ and Ⅲ IVH is poor. Therefore, cranial CT scan in the diagnosis of neonatal IVH and prognosis have important value.