早产儿梗阻性脑积水外科治疗与预后的临床研究

Effect of surgical treatment on prognosis in preterm infants with obstructive hydrocephalus

摘要:

目的 探讨早产儿梗阻性脑积水外科治疗与预后关系。 方法 回顾性选择49例梗阻性脑积水早产儿为研究对象，根据治疗方案分为外科干预组12例，保守治疗组37例。分析外科干预组的引流方式、并发症及最终分流，以及分析比较两组脑积水病因、两组治疗方式与预后的相关性。 结果 49例梗阻性脑积水早产儿中，严重颅内出血（37例，76%）和中枢神经系统感染（10例，20%）是脑积水主要病因，但外科干预组和保守治疗组病因构成差异无统计学意义（P>0.05）。外科干预组4例行侧脑室-帽状腱膜下分流，8例行Ommaya储液囊分流；1例继发感染；8例最终行脑室腹腔分流。外科干预组存活率高于保守治疗组（P<0.05）。37例严重颅内出血者中，外科干预组神经发育正常比例高于保守治疗组（P<0.05）。10例中枢神经系统感染者中，两组神经发育异常比例差异无统计学意义（P>0.05）。 结论 早产儿梗阻性脑积水外科干预可有效提高存活率，改善严重颅内出血早产儿的预后。

Abstract:

Objective To study the effect of surgical treatment on prognosis in preterm infants with obstructive hydrocephalus. Methods A retrospective analysis was performed on the medical data of 49 preterm infants with obstructive hydrocephalus. According to the treatment regimen, they were divided into two groups: surgical treatment (n=12) and conservative treatment (n=37). The drainage methods, drainage complications, and eventual shunt outcome were analyzed in the surgical treatment group. The two groups were compared in terms of the etiology of hydrocephalus and prognosis. Results Among the 49 preterm infants with obstructive hydrocephalus, severe intracranial hemorrhage (37 cases; 76%) and central nervous system infection (10 cases, 20%) were the main causes of hydrocephalus. There was no significant difference in the composition of etiology between the two groups (P>0.05). In the surgical treatment group, 4 infants were treated with ventriculosubgaleal shunt and 8 were treated with Ommaya reservoir. One infant had secondary infection and 8 infants eventually underwent ventriculoperitoneal shunt. The surgical treatment group had a significantly higher survival rate than the conservative treatment group (P<0.05). As for the 37 preterm infants with severe intracranial hemorrhage, the surgical treatment group had a significantly higher proportion of infants with normal neurodevelopment than the conservative treatment group (P<0.05). As for the 10 preterm infants with central nervous system infection, neurodevelopmental abnormalities were observed in each of the two groups. Conclusions Surgical treatment can improve the survival rate of preterm infants with obstructive hydrocephalus and the prognosis of preterm infants with severe intracranial hemorrhage.