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目的重度脑室内出血常导致脑积水及其它后遗症,本文评估连续腰穿对新生儿重度脑室内出血(IVH)的疗效。方法对我院1993年以来30例行连续腰穿(LP)治疗的严重脑室内出血(IVH)患儿进行疗效评估。并与30例未予任何防治IVH后脑积水措施的严重IVH进行对照。结果 经连续LP治疗的30例中,25例患儿的脑室停止扩张并明显缩小,有效率83.3％。初次LP日龄为(15.0±13.5)d,疗程(16.9±12.9)d,平均LP次数(6.4±4.7)次,平均LP间隔时问(2.9±2.7)d,平均每次脑脊液放液量(6.7±1.6)ml。LP治疗后起效时间为(9.6±5.5)d。10例在连续LP同时联用乙酰唑胺治疗,患儿增大的脑室在1-2周左右恢复正常或趋于稳定。25例中18例平均随访(8.3±1.9)月,体格、智能发育均正常,B超显示14例脑室形态正常,4例脑室轻度增大。每次脑脊液放液量>5 ml者及腰穿间隔时间<2 d者有效率明显较高(P<0.05或0.01)。对照组中23例脑室中重度扩张(其中6例并发脑积水),3例失访。结论 连续LP为治疗新生儿严重IVH的安全有效方法,可有效防止脑积水的发生发展。
Purpose Severe intraventricular hemorrhage often leads to hydrocephalus and other sequelae. This article evaluates the efficacy of continuous lumbar puncture on neonatal severe intraventricular hemorrhage (IVH). Methods Thirty patients with severe intraventricular hemorrhage (IVH) who underwent continuous lumbar puncture (LP) in our hospital since 1993 were evaluated. And compared with 30 cases of severe IVH without any measures of prevention and treatment of hydrocephalus after IVH. Results Among the 30 cases treated with continuous LP, the ventricles of 25 children stopped dilating and conspicuously contracted with an effective rate of 83.3%. The mean age of first LP was (15.0 ± 13.5) days, the duration of treatment was (16.9 ± 12.9) days, the average number of LP was (6.4 ± 4.7) times and the mean LP interval was (2.9 ± 2.7) days. 6.7 ± 1.6) ml. LP treatment onset time was (9.6 ± 5.5) d. 10 cases of continuous LP in combination with acetazolamide treatment, children with enlarged ventricle in 1-2 weeks to return to normal or stable. Among 25 cases, 18 cases were followed up for an average of 8.3 ± 1.9 months. Physical and mental development were normal. B-mode ultrasound showed normal ventricular morphology in 14 cases and mild ventricular enlargement in 4 cases. Each cerebrospinal fluid effusion greater than 5 ml and lumbar puncture interval of <2 d was significantly higher (P <0.05 or 0.01). In the control group, 23 cases of moderate to severe ventricular dilation (including 6 cases of hydrocephalus), 3 cases were lost. Conclusions Continuous LP is a safe and effective method for the treatment of severe IVH in neonates, which can effectively prevent the occurrence and development of hydrocephalus.