Zhang Luyi,Zhang Gang,Zhang Yuhang,et al.A case-control study of continuous external ventricular drainage for severe intraventricular hemorrhage in neonates and long-term neurofunctional outcomes[J].Journal of Clinical Pediatric Surgery,2026,(02):124-129.[doi:10.3760/cma.j.cn101785-20251030-00031]
持续脑室外引流治疗新生儿重度脑室内出血的疗效与长期神经功能评估
- Title:
- A case-control study of continuous external ventricular drainage for severe intraventricular hemorrhage in neonates and long-term neurofunctional outcomes
- Keywords:
- Intraventricular Hemorrhage; Infant; Newborn; Drainage; Treatment Outcome; Neurological Rehabilitation; Prognosis
- 摘要:
- 目的 探讨持续脑室外引流术治疗新生儿重度脑室内出血的临床疗效及长期神经功能。方法 本研究采用回顾性队列研究,以2020年1月至2025年1月西安市儿童医院神经外科收治的49例新生儿重度脑室内出血病例作为研究对象。根据治疗方案的不同,将患儿分为手术组(n=32,接受脑室储液囊埋置或皮下移行脑室外引流术)和非手术组(n=17,接受腰椎穿刺术联合药物治疗)。于入院时以及术后第7天、第14天、第30天、3个月测量并比较两组患儿脑室宽度与颅骨宽度,计算Evans指数,评价持续脑室外引流术对控制新生儿脑室内出血后脑积水进展的效果,以及对于降低后续脑室-腹腔分流术需求的作用。同时,比较两组患儿1岁时神经发育与功能评分差异,评价持续脑室外引流术对患儿远期神经系统发育的影响。结果 术后第30天,手术组患儿侧脑室宽度[(35.2±11.0)mm比(42.5±8.9)mm]与颅骨宽度[(93.8±9.6)mm比(101.6±7.1)mm]均显著小于非手术组,差异具有统计学意义(P<0.05);术后3个月随访时,手术组发生脑积水的概率明显低于非手术组(16/32比14/17),差异有统计学意义(P<0.05)。随访至1岁时,手术组患儿的神经发育评分总体优于非手术组,手术组语言发育障碍缓解更为显著(P<0.05)。结论 对于新生儿重度脑室内出血,采用持续脑室外引流术可有效清除脑室内积血,显著降低脑积水发生概率,减少头围的异常增长,并能降低因脑出血及继发性脑积水所致的神经系统发育障碍风险,进而改善远期神经功能。
- Abstract:
- Objective To investigate the clinical efficacy of continuous external ventricular drainage in the treatment of severe intraventricular hemorrhage in neonates and to evaluate long-term neurofunctional outcomes. Methods This retrospective case-control study included 49 neonates with severe intraventricular hemorrhage.According to the treatment strategy,patients were divided into a surgical group (n=32),who underwent implantation of a ventricular reservoir or subcutaneous translocation external ventricular drainage,and a non-surgical group (n=17).Ventricular width and cranial width were measured at admission and at 7,14,30 days,as well as at 3 months after surgery,and the Evans index was calculated.The effectiveness of continuous external ventricular drainage in controlling the progression of post-hemorrhagic hydrocephalus and in reducing the subsequent need for ventriculoperitoneal shunting was evaluated.In addition,neurodevelopmental and functional scores at 1 year of age were compared between the two groups to assess the impact of continuous external ventricular drainage on long-term neurological development. Results At 30 days after admission,both lateral ventricular width and cranial width in the surgical group were significantly smaller than those in the non-surgical group,with statistically significant differences (P<0.05).At the 3-month follow-up,the incidence of hydrocephalus in the surgical group was significantly lower than that in the non-surgical group (P<0.05).At 1-year follow-up,overall neurodevelopmental scores in the surgical group were superior to those in the non-surgical group,with more pronounced improvement in language developmental delay in the surgical group (P<0.05). Conclusions For neonates with severe intraventricular hemorrhage,continuous external ventricular drainage can effectively remove intraventricular blood,significantly reduce the incidence of hydrocephalus and abnormal head circumference growth,and decrease the risk of neurodevelopmental impairment caused by intracranial hemorrhage and secondary hydrocephalus,thereby improving long-term neurological outcomes.
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备注/Memo
收稿日期:2025-10-30。
通讯作者:史航宇,Email:hangyushi_2023@163.com