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目的:探讨新生儿缺氧缺血性脑病(HIE)行高压氧(HBO)治疗前、中、后脑部CT所表现的动态变化与临床效果对比。方法:回顾性分析85例HIE新生儿的临床和CT资料,按照治疗前脑部CT表现分为轻、中、重三型,行HBO及常规辅助治疗于1、2、3个疗程后分别行脑部CT复查,对三型HIECT转归情况与临床效果进行对比分析。结果:85例患儿行HBO治疗前CT检查,其中轻度HIE20例,中度HIE42例,重度HIE合并脑出血23例;HBO及常规辅助治疗1个疗程后复查CT,轻度HIE中有9例转阴,临床症状恢复正常,还有11例轻度的和中度的、重度的HIE与治疗前CT检查结果相比有好转,临床症状减轻,CT总转归率为11.12%(9/85);HBO及常规辅助治疗2个疗程后复查CT,轻度的20例HIE全部转阴,中度的HIE中有30例转阴,CT总转归率58.82%(50/85),其中中度的12例及重度的23例与治疗前CT检查结果明显好转,临床症状亦明显减轻;HBO及常规辅助治疗3个疗程后复查CT,中度的HIE全部转阴,重度的HIE中有12例转阴,CT总转归率87.06%(74/85),其中重度的HIE合并脑内出血的11例患儿,CT示出血全部吸收,留下软化灶,临床症状明显好转。结论:应用CT显示新生儿脑部动态变化对HBO治疗HIE有重要指导价值。
Objective: To investigate the dynamic changes of CT in the brain of neonatal hypoxic-ischemic encephalopathy (HIE) treated with hyperbaric oxygen (HBO) compared with the clinical results. Methods: The clinical and CT data of 85 neonates with HIE were retrospectively analyzed. According to the CT findings of the anterior cerebral cortex before treatment, they were divided into mild, moderate and severe types. HBO and conventional adjuvant therapy were given after 1,2,3 courses CT review of the brain, the type III HIECT outcome and clinical results were compared. Results: Eighty-five children underwent CT scan before HBO treatment, including 20 mild HIE patients, 42 moderate HIE patients and 23 severe HIE patients with intracerebral hemorrhage. HBO and conventional adjuvant therapy were followed up for 1 month after treatment. CT was found in mild HIE Cases of negative, clinical symptoms returned to normal, there are 11 cases of mild and moderate, severe HIE CT scan results compared with before treatment were improved, clinical symptoms reduced, CT total recovery rate was 11.12% (9 / 85). After two courses of HBO and conventional adjuvant therapy, CT was retrospectively reviewed. Twenty of the mild HIE were negative, 30 of the moderate HIE were negative, and the total CT was 58.82% (50/85) 12 cases of moderate and 23 cases of severe with pre-treatment CT examination results improved significantly, clinical symptoms were significantly reduced; HBO and conventional adjuvant therapy after 3 courses of review CT, moderate HIE all negative, severe HIE in Twelve cases were negative and the total CT rate was 87.06% (74/85). Among 11 cases of severe HIE complicated with intracerebral hemorrhage, CT showed that all the blood was absorbed, leaving a soft spot and the clinical symptoms were obviously improved. Conclusion: The dynamic changes of neonatal brain using CT imaging are of great guiding value in the treatment of HIE by HBO.