新生儿缺氧缺血性脑病磁共振诊断与损伤类型的分类建议

发布时间：2018-01-28 10:26

本文关键词： 脑缺氧缺氧缺血性脑病磁共振成像新生儿　出处：《中国当代儿科杂志》2017年12期 　论文类型：期刊论文

【摘要】：新生儿缺氧缺血性脑病(HIE)有比较统一的临床诊断与分度标准,但是符合相同诊断标准的窒息所致HIE的临床表现、神经病理损伤类型有很大差异。磁共振成像(MRI)能很好地呈现HIE损伤类型、损伤进程,且与其远期神经发育结局密切相关,但不同MRI检查序列所反映的损伤表现可能不尽相同。弥散加权序列适宜的检查时间为出生后2~4 d,常规序列为出生后的4~8 d。HIE的MRI主要损伤类型有丘脑基底节+内囊后肢损伤、分水岭样损伤累及皮层和皮层下白质、局灶-多灶性微小性白质损伤,以及广泛全脑性损伤。严重的急性产时窒息易导致深部灰质损伤(丘脑基底节),也可累及脑干,锥体束是最易受累的白质纤维束,而反复间断性缺氧缺血以及伴有感染、低血糖等易导致分水岭区和深部白质损伤。但上述损伤类型有时很难明确区分,而是以某一类型为主,并非所有HIE都有特征性的MRI表现。
[Abstract]:Neonatal hypoxic-ischemic encephalopathy (HIE) has a relatively unified clinical diagnosis and grading criteria, but the same diagnostic criteria for asphyxia caused by HIE clinical manifestations. The type of neuropathic injury is very different. Magnetic resonance imaging (MRI) can well present the type and progression of HIE damage, and is closely related to its long-term neurodevelopmental outcome. However, different MRI sequences may not reflect the same damage performance. The appropriate time of DWI is 2d after birth. The main types of MRI damage in postnatal 4 ~ 8 d.HIE included posterior limb injury in thalamic basal ganglia and watershed injury in cortex and subcortical white matter. Focal and multi-focal minimal white matter injury and extensive global brain injury. Severe acute asphyxia may lead to deep gray matter damage (thalamic basal ganglia or brain stem involvement). Pyramidal tract is the most easily involved white matter fiber bundle, and repeated intermittent hypoxic ischemia with infection, hypoglycemia and other prone to lead to watershed and deep white matter damage, but the type of damage is sometimes difficult to distinguish clearly. Not all HIE have characteristic MRI performance.
【作者单位】：中国医师协会新生儿科医师分会;中国医科大学附属盛京医院儿科;
【分类号】：R445.2;R722.1
【正文快照】： 新生儿缺氧缺血性脑病(hypoxic-ischemic及必要的新生儿急救物品。MRI仪磁场强度最好encephalopathy,HIE)是围生期急性缺氧缺血导致为1.5Tesla或3.0Tesla。患儿在检查前应做以下的最常见中枢神经系统疾病。尽管多种综合治疗包准备:(1)去除患儿身上的金属物品,若需要括亚低温治

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