Zhang Yi,Li Hao.Precision management of posthemorrhagic hydrocephalus following intraventricular hemorrhage in preterm infants: a multimodal assessment and individualized therapeutic strategy[J].Journal of Clinical Pediatric Surgery,2026,(02):101-106.[doi:10.3760/cma.j.cn101785-20260108-00011]
早产儿脑室内出血后脑积水的精准管理:多模态评估与个体化诊治策略
- Title:
- Precision management of posthemorrhagic hydrocephalus following intraventricular hemorrhage in preterm infants: a multimodal assessment and individualized therapeutic strategy
- Keywords:
- Cerebral Intraventricular Hemorrhage; Hydrocephalus; Infant; Premature; Diagnosis; Therapy; Precision Medicine
- 摘要:
- 早产儿脑室内出血后脑积水是早产儿常见且严重的疾病,其临床管理涉及多学科协作与多阶段决策。本文系统阐述该病的病理生理机制,指出出血后炎症反应、脑脊液循环障碍是脑室扩张与脑损伤的核心环节。诊断方面,颅脑超声动态监测结合"三色风险分层"框架,实现了从经验判断向量化、分层决策的转变。治疗上,外科干预仍然是主流观点,临时性脑室外引流与脑室-腹腔分流术构成当前治疗体系的主体;早期外科干预虽未能显著降低永久分流率,但可能改善神经发育结局。新兴的神经内镜下血肿灌洗术显现出降低分流率与改善预后的潜力。未来该疾病的管理将趋向精准化与个体化,结合多模态评估与再生医学策略,最大程度保护神经发育潜能。
- Abstract:
- Posthemorrhagic hydrocephalus following intraventricular hemorrhage is a common and severe complication in preterm infants,and its clinical management requires multidisciplinary collaboration and stage-specific decision-making.This review systematically summarizes the pathophysiological mechanisms of the disease,highlighting posthemorrhagic inflammatory responses and cerebrospinal fluid circulation impairment as keycontributors to ventricular dilation and secondary brain injury.In terms of diagnosis,dynamic cranial ultrasound surveillance combined with a "traffic-light" risk stratification framework enables a transition from experience-based judgment to quantitative and tiered clinical decision-making.Regarding treatment strategies,surgical intervention remains the cornerstone of current management.Temporary cerebrospinal fluid diversion,including ventricular reservoir placement or external ventricular drainage,together with ventriculoperitoneal shunting,constitutes the mainstay of therapy.Although early surgical intervention has not consistently demonstrated a reduction in permanent shunt dependency,it may contribute to improved neurodevelopmental outcomes.Emerging minimally invasive approaches,particularly neuroendoscopic ventricular lavage,have shown promise in reducing shunt rates and improving long-term prognosis.Looking forward,management of posthemorrhagic hydrocephalus in preterm infants is expected to evolve toward precision-based and individualized care,integrating multimodal assessment tools and regenerative medicine strategies to maximize neurodevelopmental potential.
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备注/Memo
收稿日期:2026-1-8。
基金项目:国家重点研发计划(2021YFC2701003)
通讯作者:李昊,Email:li_hao@fudan.edu.cn