- 期刊
Periventricular Hemorrhage/Intraventricular Hemorrhage in Premature Infants
早産兒的腦內出血
摘要
在早産兒，尤其是出生體重輕於1,500公克者；因腦室週圍原生質層(Germinal matrix)富含結構脆弱的微血管叢加以腦血流的自動調節機能尚未穩定，易受出生後種種外圍環境改變所影響，因此容易引起腦室週圍原生質層的出血，進而形成腦室出血或大腦內的出血；在文獻的報告中其發生率可高達45-55%，且是早産兒重要的死亡原因之一。從民國72年5月至9月前後5個月的期間內，在彰化基督教醫院我們使用扇形實時間超音波(Ultrasound Sector Scan, ATL Mark Ⅲ)及5MHz的掃描頭對於92個早産兒進行腦部的掃描。其中51個病歷被診斷爲腦內出血；他們平均的懷孕週數爲30.78±2.41週。平均的出生體重爲1583±514公克，都比沒有腦出血的早産兒來得較不成熟。其出生之體重也較輕，而且這些患兒皆擁有較低的Apgar score，在出生時曾接受過急救的處置。同時，在這5個月的期間，凡在本院出生而懷孕週數小於33週或者出生體重小於1,500公克的早産兒我們都在出生後不久即進行一系列的腦內超音波之探測。而且較大的早産兒若合併其他之併發症（如：呼吸系統之疾病，抽搐，貧血或臨床情祝之惡化等。）也都施予腦部超音波之掃描。我們發現，合併有腦內出血之或然率隨著懷孕週期的增加或出生體重的上昇而逐漸地減少。依照我們的資料顯示，在懷孕週期小於32週的早産兒有58.33%的機會合併有腦內出血而在出生體重小於1,500公克者有56%會合併腦部出血。若懷孕週數大於32週或出生體重超過1,500公克的早産兒，其産生腦內出血的機會就大大的降低了。除此之外，我們列舉了一些因素（如：出生的地方，新生兒呼吸窘迫症候羣，新生兒窒息，呼吸器之使用，血中二氧化碳，酸齡度以及嬰兒之體溫，血壓等）來探討這些因素與腦內出血之關係。不但如此，依據超音波上所見之分類，也可以用爲預測這些患兒預後的一個重要的指標。
關鍵字
無資料並列摘要
It has been reported that approximately 45-55% of all premature infants born weighing less than 1,500gm were found to have periventricular-intraventricular or intracerebral hemorrhage (PVH/IVH). A relatively prominent blood supply, tenuous integrity, impaired autoregulation of the capillaries in the germinal matrix and the environmental factors have been proposed as the major pathogenesis of the hemorrhage. A real time sector scanner (ATL, Mark Ⅲ) with portable equipment was used for evaluating intracranial lesions of 92 premature infants in Changhua Christian Hospital in the period May to September 1983. These babies had the gestational age ranged from 26 to 36 weeks (mean 30.78±2.41 week) and with birth weight ranged from 700gm to 2,490gm (mean 1,583±514 gm). Fifty-one of them developed PVH/IVH. The mean gestational age, mean birth weight and Apgar scores were lower in those infants with hemorrhage and resuscitation during birth was usually needed, too. During the five-month period, the infants with birth weight of 1,500gm or less and with a gestational age of less than 32 weeks were routinely surveyed. The other group of preterms weighing from 1,500 gm to 2,500 gm were also scanned whenever hemorrhage was supsected. We found that 58.33% of the infants with gestational age of 32 weeks or less and 56% of babies weighing under 1,500gm suffered a PVH/IVH. The incidence of hemorrhage decreased dramatically with gestational Period more than 32 weeks and birth weight above 1,500 gm infants. Besides, certain identifiable risk factors, such as: prematurity, asphyxia, need for resuscitation, postnatal transfer, RDS, mechanical ventilation, hypercapnia acidosis, hypothermia, hypotension were analyzed in relation to the development of PVH/IVH. Meanwhile, sonographic grading of intracerebral hemorrhage can be used as an important prognostic indicator of these infants.