Liu Bo,Deng Ke,Xie Shigang,et al.Clinical characteristics and surgical treatment analysis of intracranial hemorrhage in full-term neonates[J].Journal of Clinical Pediatric Surgery,2026,(02):136-139.[doi:10.3760/cma.j.cn101785-20251027-00018]
足月新生儿颅内出血的临床特点与手术治疗分析
- Title:
- Clinical characteristics and surgical treatment analysis of intracranial hemorrhage in full-term neonates
- Keywords:
- Infant; Newborn; Term Birth; Intracranial Hemorrhages; Pathological Conditions; Signs and Symptoms; Surgical Procedures; Operative; Postoperative Complications
- 摘要:
- 目的 分析足月新生儿颅内出血的主要临床表现、出血原因、手术方式及术后并发症情况,提高临床对足月新生儿颅内出血的认识与诊疗水平。方法 采取回顾性分析方法,以济南市儿童医院(山东大学附属儿童医院)神经外科和新生儿科自2018年6月至2024年6月收入院并行手术治疗的37例足月新生儿颅内出血患儿作为研究对象。收集并分析患儿年龄、性别、分娩方式、临床表现、病因、手术方式以及术后并发症情况等。结果 患儿平均年龄8.97 d(范围1~28 d),其中男22例(59.46%),女15例(40.54%);剖宫产15例(40.54%),顺产22例(59.46%);就诊原因:惊厥20例(54.05%),拒乳7例(18.92%),反应差9例(24.32%),黄疸5例(13.51%),头部包块5例(13.51%),呼吸暂停1例(2.70%),口角歪斜1例(2.70%)。出血部位:硬膜外5例(13.51%);硬膜下4例(10.81%);脑实质出血22例(59.46%),其中额叶2例(5.47%)、颞叶4例(10.81%)、顶叶9例(24.32%)、枕叶4例(10.81%)、岛叶3例(8.11%)、后颅窝8例(21.62%)、脑室5例(13.51%)。出血原因:动静脉畸形15例(40.54%),动脉瘤2例(5.41%),凝血功能异常10例(27.03%),机械性损伤5例(13.51%),原因不明5例(13.51%)。手术方式:开颅血肿清除术27例(72.97%),颅骨钻孔引流术10例(27.03%)。术后并发证:脑积水5例(13.51%,均行脑室-腹腔分流术),癫痫4例(10.81%),肢体活动障碍3例(8.11%)。结论 足月新生儿颅内出血临床表现多样、无特异性,病因较为复杂,完善颅脑影像学检查和实验室检查有助于病因诊断和及时手术治疗,进而改善预后。
- Abstract:
- Objective To analyze the main clinical manifestations,causes of hemorrhage,surgical approaches,and postoperative complications of intracranial hemorrhage in full-term neonates,and to improve clinical understanding and diagnostic and therapeutic management of this condition. Methods A retrospective analysis was conducted on 37 full-term neonates with intracranial hemorrhage who were admitted and underwent surgical treatment in the Department of Neurosurgery and Neonatology at Jinan Children’s Hospital (Children’s Hospital Affiliated to Shandong University) between June 2018 and June 2024.Data on age,gender,mode of delivery,clinical manifestations,etiology,surgical methods,and postoperative complications were collected and analyzed. Results The mean age of the neonates was 8.97 days (range,1-28 days).There were 22 male infants (59.46%) and 15 were female infants (40.54%).15 cases (40.54%) were delivered by cesarean section and 22 cases (59.46%) by vaginal delivery.Reasons for presentation included seizures in 20 cases (54.05%),feeding refusal in 7 cases (18.92%),poor responsiveness in 9 cases (24.32%),jaundice in 5 cases (13.51%),scalp mass in 5 cases (13.51%),apnea in 1 case (2.70%),and deviation of the angle of the mouth in 1 case (2.70%).Hemorrhage locations included epidural hemorrhage in 5 cases(13.51%),subdural hemorrhage in 4 cases(10.81%),and intracerebral hemorrhage in 22 cases (59.46%),involving the frontal lobe in 2 cases (5.41%),temporal lobe in 4 cases (10.81%),parietal lobe in 9 cases (24.32%),occipital lobe in 4 cases (10.81%),insular lobe in 3 cases (8.11%),posterior cranial fossa in 8 cases (21.62%),and intraventricular hemorrhage in 5 cases (13.51%).The causes of hemorrhage were arteriovenous malformations in 15 cases (40.54%),aneurysms in 2 cases (5.41%),coagulation dysfunction in 10 cases (27.03%),mechanical injury in 5 cases (13.51%),and unknown causes in 5 cases (13.51%).Surgical procedures included craniotomy with hematoma evacuation in 27 cases (72.97%) and burr-hole drainage in 10 cases (27.03%).Postoperative complications included hydrocephalus in 5 cases (13.51%),all of which required ventriculoperitoneal shunting,epilepsy in 4 cases (10.81%),and limb motor dysfunction in 3 cases (8.11%). Conclusions Intracranial hemorrhage in full-term newborns presents with diverse and non-specific clinical manifestations and has complex etiologies.Comprehensive neuroimaging and laboratory examinations facilitate etiological diagnosis and timely surgical intervention,thereby improving prognosis.
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备注/Memo
收稿日期:2025-10-27。
通讯作者:王广宇,Email:jnsetyysjwk@163.com