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Noninvasive Measurement of Intracranial Pressure in Normal Chinese Newborns

正常新生兒顱內壓之非侵襲性偵測

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摘要


新生兒顱內壓的偵測對於神經疾患的診治有很大的參考價值。在這個年齡羣,可以經山完整的前囱門,利用非侵襲性的方法測得顱內壓。目前較常用的方法是利用光纖維(fiberoptic)的原理,將顱內壓經由前囱門傳到感應器,再經由記錄器顯示出數值。過去文獻上的報告顯示用這種方法偵測的顱內壓和實際所測得的顱內壓相近。本文報告本院臨床上使用此種測定器偵測正常中國新生兒出生後幾天的顱內壓正常值和其變化情形,以為日後應用的參考。 從民國73年12月至民國74年1月,在本院嬰兒室共收集新生兒309名。扣除前囱門過於狹小,出生3天內出院的嬰兒,或頭皮有明顯的生產損傷,總共有218名新生兒接受3天以上的前囱門壓力測定,其中自然生產157名(男性86名,女性71名),剖腹生產37名,使用產鉗或真空抽引器24名。平均體重32公斤。 結果:足月自然生產前3天平均顱內壓分別為8.76±2.00,10.38±1.83, 11.06±1.94公分水柱。剖腹生產為8.00±1.76, 9.24±1.70, 10.16±1.68公分水柱。使用產鉗或真空抽引器為9.58±2.26, 11.21±1.91, 11.96±2.60公分水柱。這三羣嬰兒的顱內壓在出生6小時以內並無差異,其增高主要發生在出生6小時以後,至第3天轉趨穩定。使用產鉗或真空抽引器的新生兒顱內壓在出生幾天比另外兩羣為高。本研究同時明顯看出頭部位置的改變和身體的活動均會影響顱內壓的偵測結果。 根據我們的經驗,這種非侵襲性的顱內壓偵測是準確而容易操作的。明瞭正常新生兒的顱內壓變化趨勢,且在偵測時避免一些可能影響偵測結果的因素,可以幫助我們及早發現病嬰之顱內壓變化,以便迅速治療。

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並列摘要


Noninvasive measurement through the intact anterior fontanel is a preferred method to detect the intracranial pressure (ICP) value in the neonate. This paper we presents our experience in measuring anterior fontanel pressure (AFP) using a pressure-activated fiberoptic device (Ladd 1000). There was good correlation between AFP and pressure recorded by lumbar or ventricular puncture (r=0.99, P<0.005). Fontanel pressure was measured sequentially in 218 full term babies during the first three days after birth. Mean birth weight was 3.2Kg. On day 1, 2and 3 respectively, mean ICP were 8.76±2.00, 10.38±1.83, 11.06±1.94 cmH2O in babies born by normal spontaneous delivery and 8.00±1.76, 9.24±1.70, 10.16±1.68 cmH2O in babies delivered by Caesarean section and 9.58±2.26, 11.21±1.91, 11.96±2.60 cmH2O in babies delivered by vacuum and/or forceps delivery. The major increase of .ICP occurred after 6 hours on day 1. The ICP varied little after day three in these three groups. Babies born by vacuum and/or forceps extraction had a higher mean ICF than the rest. This monitor also showed subtle changes in measurement with the change of head position and physical activities.

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