Wu Shuihua.Classification characteristics and management strategies of germinal matrix-intraventricular hemorrhage in preterm infants[J].Journal of Clinical Pediatric Surgery,2026,(02):107-110.[doi:10.3760/cma.j.cn101785-20251029-00024]
早产儿生发基质-脑室内出血的分型特点与管理策略
- Title:
- Classification characteristics and management strategies of germinal matrix-intraventricular hemorrhage in preterm infants
- Keywords:
- Preterm; Germinal Matrix-Intraventricular Hemorrhage; Posthemorrhagic Hydrocephalus; Microsurgery; Ventriculoperitoneal Shunt; Neurodevelopmental Outcome; Ventricular Index
- 摘要:
- 随着围产医学与新生儿重症监护技术的进步,早产儿及极低出生体重儿的存活率显著提升,但早产儿脑损伤仍然是影响患儿远期生存质量的重要因素。生发基质-脑室内出血(germinal matrix-intraventricular hemorrhage,GMH-IVH)及其继发的出血后脑室扩张和出血后脑积水,是导致患儿脑瘫、认知障碍及癫痫的主要原因。GMH-IVH的临床诊疗涉及多学科协作,如何透过影像学分型洞察病理本质、利用量化指标把握外科干预时机以及制定个体化的引流方案是当前面临的核心问题。本文结合国内外最新循证医学证据,从神经外科视角剖析GMH-IVH的病理生理机制与分型内涵,构建基于经颅超声多参数量化的序贯评估体系;在治疗策略上,倡导依据病情演变实施从集束化监护、临时性脑脊液引流到永久性分流的"阶梯化"管理策略,为早产儿GMH-IVH的规范化诊疗提供参考。
- Abstract:
- With advances in perinatal medicine and neonatal intensive care technologies,the survival rates of extremely preterm infants and extremely low birth weight infants have increased significantly; however,brain injury in preterm infants remains a major constraint on long-term quality of survival.Germinal matrix-intraventricular hemorrhage (GMH-IVH) and its secondary complications,including posthemorrhagic ventricular dilatation (PHVD) and posthemorrhagic hydrocephalus (PHH),are the leading causes of cerebral palsy,cognitive impairment,and epilepsy in survivors.The clinical diagnosis and management of GMH-IVH require multidisciplinary collaboration.Key current challenges include elucidating the pathological essence through imaging-based classification,determining the optimal timing for surgical intervention using quantitative indicators,and formulating individualized drainage strategies.Integrating the latest domestic and international evidence-based medical data,this article provides an in-depth analysis from a neurosurgical perspective of the pathophysiological mechanisms and classification connotations of GMH-IVH,and constructs a sequential assessment system based on multiparametric quantitative transcranial ultrasonography.In terms of treatment strategies,a "stepwise" management approach is advocated according to disease progression,ranging from bundled monitoring and temporary cerebrospinal fluid drainage to permanent shunting,thereby providing a reference for the standardized diagnosis and treatment of GMH-IVH in preterm infants.
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备注/Memo
收稿日期:2025-10-29。
基金项目:湖南省自然科学基金(2025JJ50682)
通讯作者:吴水华,Email:292454021@qq.com