131例婴幼儿期自发性颅内出血临床分析

杨莎; 翟瑄; 梁平; 周渝冬; 于增鹏; 邹彬; 纪文元; 周建军

doi:10.16016/j.1000-5404.202003197

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131例婴幼儿期自发性颅内出血临床分析

神经科学 | 更新时间：2026-01-09

- 131例婴幼儿期自发性颅内出血临床分析
- Spontaneous intracranial hemorrhage in infants: a clinical analysis of 131 cases
- 第三军医大学学报 2020年42卷第15期页码：1495-1500
- 作者机构：
  
  400014 重庆，重庆医科大学附属儿童医院神经外科
- 作者简介：
  
  [ 翟瑄，E-mail:zhaixuan@163.com ZHAI Xuan, E-mail:zhaixuan@163.com
- 基金信息：
  
  国家自然科学基金面上项目(81971217)
- DOI：10.16016/j.1000-5404.202003197
  中图分类号： R181.32;R729;R743.34
- 收稿：2020-03-16，
  
  修回：2020-05-13，
  
  纸质出版：2020-08-15
- 稿件说明：
移动端阅览
杨莎, 翟瑄, 梁平, 等. 131例婴幼儿期自发性颅内出血临床分析[J]. 第三军医大学学报, 2020,42(15):1495-1500.

Sha YANG, Xuan ZHAI, Ping LIANG, et al. Spontaneous intracranial hemorrhage in infants: a clinical analysis of 131 cases[J]. Journal of Third Military Medical University, 2020, 42(15): 1495-1500.
杨莎, 翟瑄, 梁平, 等. 131例婴幼儿期自发性颅内出血临床分析[J]. 第三军医大学学报, 2020,42(15):1495-1500. DOI： 10.16016/j.1000-5404.202003197.

Sha YANG, Xuan ZHAI, Ping LIANG, et al. Spontaneous intracranial hemorrhage in infants: a clinical analysis of 131 cases[J]. Journal of Third Military Medical University, 2020, 42(15): 1495-1500. DOI： 10.16016/j.1000-5404.202003197.

摘要

目的

探讨婴幼儿自发性颅内出血的病因、影像学特点、并发症及治疗预后。

方法

回顾性分析2011-2018年我科收治的131例婴幼儿期(≤3岁)自发性颅内出血患儿的临床诊断、影像学检查结果、并发症、治疗方法及预后。

结果

本组患儿的出血病因主要包括晚发型维生素K依赖因子缺乏症72例(54.9%)、动静脉畸形16例(12.2%)、血友病15例(11.4%)、不明原因凝血功能障碍9例(6.9%)、海绵状血管瘤5例(3.8%)、缺氧缺血性脑病4例(3.1%)、脑肿瘤卒中3例(2.3%)、脑型肺吸虫病2例(1.5%)、动脉瘤2例(1.5%)、急性白血病1例(0.8%)，嗜血细胞综合征1例(0.8%)、颅面血管瘤1例(0.8%)。患儿均由CT或MRI检查明确颅内出血诊断，其中34例疑诊脑血管病变者均行CTA检查，检出率为100%。主要并发症包括抽搐或惊厥发作86例(65.6%)、贫血77例(58.8%)、继发感染46例(35.1%)、脑疝32例(24.4%)、脑水肿28例(21.4%)、脑梗塞27例(20.6%)、脑积水26例(19.8%)、呼吸衰竭14例(10.6%)、惊厥持续状态9例(6.9%)。手术治疗43例，非手术治疗88例。预后评估采用GOS评分，预后良好100例(76.3%)。经二元Logistic回归分析结果显示，并发症中脑水肿(

=5.794)、脑疝(

=11.326)和呼吸衰竭(

=8.028)是患儿预后不良的危险因素(

0.05)。

结论

婴幼儿期自发性颅内出血的病因以晚发性维生素K依赖因子缺乏症最常见；出血病因疑诊为脑血管病变者应尽早行CTA检查；并发症以抽搐或惊厥发作最常见；脑水肿、脑疝及呼吸衰竭出现常提示预后不良；该病经积极治疗预后良好。

Abstract

Objective

To explore clinical features of the etiology

imaging characteristics

complications and prognosis of spontaneous intracranial hemorrhage in infants.

Methods

Clinical data of 131 cases of spontaneous intracranial hemorrhage in infants (≤3 years old) admitted to our department from January 2011 to December 2018 were collected and retrospectively analyzed

including their clinical etiology

imaging examination results

complications

treatment methods and prognoses.

Results

The causes of intracranial hemorrhage in this cohort included delayed vitamin K deficiency(72 cases

54.9%)

arteriovenous malformations (16 cases

12.2%)

hemophilia (15 cases

11.4%)

other unexplained coagulation dysfunction (9 cases

6.9%)

cavernous hemangioma (5 cases

3.8%)

hypoxic ischemic encephalopathy (4 cases

3.1%)

brain tumor stroke (3 cases

2.3%)

cerebral paragonimiasis and aneurysm (both 2 cases

1.5%)

and acute leukemia

hemophilic syndrome and

Sturge-Weber syndrome (all 1 case

0.8%). All cases were diagnosed with intracranial hemorrhage by CT scanning or MRI

and for the 34 cases with suspected cerebrovascular disease

the detection rate of CTA was 100%. The complications included convulsion or seizure (86 cases

65.6%)

anemia (77 cases

58.8%)

secondary infections (46 cases

35.1%)

cerebral hernia (32 cases

24.4%)

cerebral edema (28 cases

21.4%)

cerebral infarction (27 cases

20.6%)

hydrocephalus (26 cases

19.8%)

respiratory failure (14 cases

10.6%) and status convulsion (9 cases

6.9%). There were 43 cases undergone surgical treatment

and 88 cases received non-surgical treatment. Glasgow outcome score (GOS) scale indicated that 100 patients (76.3%) achieved a good prognosis. The results of binary logistic regression analysis showed that cerebral edema (

=5.794)

cerebral hernia (

=11.326) and respiratory failure (

=8.028) were risk factors for poor prognosis in the infants with spontaneous intracranial hemorrhage (

0.05).

Conclusion

The most common cause of spontaneous intracranial hemorrhage in infants is delayed vitamin K deficiency. If the cause of hemorrhage is suspected to be cerebrovascular disease

CTA examination should be conducted as early as possible. The most common complications is convulsion or seizure. Cerebral edema

cerebral hernia and respiratory failure often indicate poor prognosis. The disease can obtain a good prognosis after active treatment.

关键词

Keywords

references

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