本文關(guān)鍵詞：三維容積超聲在新生兒顱內(nèi)出血定性和定量診斷中的價值　出處：《泰山醫(yī)學(xué)院》2014年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 二維超聲 三維超聲 顱內(nèi)出血 新生兒

【摘要】：研究背景新生兒顱內(nèi)出血是在新生兒時期最常見和最重要的發(fā)生于神經(jīng)系統(tǒng)的疾病,大范圍的出血可引起嚴重后果,特別對于早產(chǎn)兒,是造成新生兒神經(jīng)系統(tǒng)死亡與發(fā)育障礙的重要原因之一。所以對新生兒顱內(nèi)出血的早期診斷顯得尤其重要。不僅可以給臨床醫(yī)師的診斷及治療提供有效的資料,指導(dǎo)其有效及合理的治療,對于取得良好預(yù)后打下基礎(chǔ),從而可以提高該病的治愈率,對于神經(jīng)系統(tǒng)后遺癥發(fā)生的減少起到了尤為重要的作用。因此深入研究及認識這些問題,將非常有益于提高臨床的診治技術(shù)及水平。超聲是利用其聲波的特性來了解人體組織結(jié)構(gòu)和其對應(yīng)病變過程的一項技術(shù),B型超聲是以灰階形式在熒屏上實時地顯示的二維顯像。20世紀70年代末超聲診斷技術(shù)開始在新生兒領(lǐng)域應(yīng)用于新生兒顱內(nèi)疾病的診斷,隨著顯像技術(shù)的進一步提高,開闊了超聲診斷的視野,腦室、各種腔隙結(jié)構(gòu)及腦實質(zhì)的變化可清晰顯示。隨著20世紀80年代電子計算機技術(shù)的飛速發(fā)展及三維超聲成像技術(shù)的成熟,Nagdyman自1999年首次利用三維超聲探查新生兒顱腦解剖結(jié)構(gòu),開辟了三維超聲應(yīng)用的的新領(lǐng)域�？衫萌S超聲精確定位顯示腦內(nèi)實質(zhì)性的病灶與周圍組織的關(guān)系,立體顯示病變大小并進行體積測量。新生兒因為出生時囟門尚未閉合,以前囟為好的透聲窗,不僅可以取得較好的顯像效果,而且為我們診斷新生兒顱內(nèi)病變提供了非常有利的條件。通過顱腦超聲檢查可以及時發(fā)現(xiàn)顱內(nèi)出血,而且能顯示出血的確切部位,并較準確地了解顱內(nèi)出血的病程進展情況以及嚴重程度,尤其對不能搬動、搶救中的危重患兒,不能離開暖箱的新生兒、需使用特殊器械比如呼吸機的新生兒不方便進行CT、MRI檢查,由于CT、M RI需搬動患兒,CT具有放射性,MRI價格昂貴、噪音大以及檢查耗時較長,不適合反復(fù)復(fù)查,而且CT與MRI檢查的斷層厚度常難以發(fā)現(xiàn)室管膜下和腦室內(nèi)較小的出血團等缺點,超聲檢查具有價格便宜、無X線損傷、無創(chuàng)傷、簡便快捷、實時、安全、成像速度快、可重復(fù)床邊檢查及隨時動態(tài)觀察患兒病情進展情況等獨特的優(yōu)勢,可廣泛用于新生兒顱內(nèi)出血連續(xù)的動態(tài)監(jiān)測,對新生兒顱內(nèi)出血的早期診斷和治療、減少可能遺留的后遺癥、降低新生兒病死率等具有非常重要的臨床指導(dǎo)價值。如果能早期對新生兒顱內(nèi)出血進行定性和定量診斷,就能更準確、及時地為臨床提供科學(xué)有效的診斷依據(jù)。但既往研究主要集中于對顱內(nèi)血腫的定性診斷,對定量研究較少,更少見定量分析與患兒預(yù)后關(guān)系的研究。目的(1)探討超聲定性診斷新生兒顱內(nèi)出血的價值;(2)研究二維超聲定量分析顱內(nèi)出血量的準確性;(3)探討三維超聲定量分析顱內(nèi)出血量的可行性和準確性、以及出血量定量分析對患兒預(yù)后的影響。方法病例來自泰安市婦幼保健醫(yī)院自2013年1月至2013年12在我院新生兒科住院,同時接受超聲與CT檢查,診斷為顱內(nèi)出血的新生兒200例,胎齡(26-41周),年齡0~31d,平均8d,男110例,女90例,其中早產(chǎn)兒80例。所用超聲儀器為PHILS-超凡、Philipsiu22彩色超聲診斷儀,頻率5~7.5MHz,高頻凸陣小型探頭,扇形掃描。對臨床上懷疑神經(jīng)系統(tǒng)疾病或顱內(nèi)出血的患兒采用二維超聲經(jīng)前囟作冠狀及矢狀掃查,對顱內(nèi)結(jié)構(gòu)進行初步篩查,并同時進行顱腦CT進行確定診斷,篩查出顱內(nèi)出血的病例,進行不同方法的對比研究。二維超聲主要觀察了解顱內(nèi)腦中線、腦室大小、脈絡(luò)叢回聲強度及腦實質(zhì)回聲等結(jié)構(gòu),并對出血量進行半定量評價。采用三維容積探頭對出血部位進行三維數(shù)據(jù)采集,使用三維超聲定量分析出血量容積。并用顱腦CT檢查檢測顱內(nèi)出血情況,以CT定量分析顱內(nèi)出血量為標準對照,分析二維超聲和三維超聲定量出血量的準確性。對所有患者進行隨訪,分析出血部位、出血量與患兒預(yù)后的關(guān)系。結(jié)果1、二維超聲可清晰診斷室管膜下出血、腦室內(nèi)出血、部分腦實質(zhì)出血以及大的硬腦膜下出血。對顱腦中央部位的出血分辨率最高。對小的硬膜下出血、蛛網(wǎng)膜下腔出血及小腦內(nèi)出血、后顱窩等顱腦邊緣部位的出血診斷較為困難。超聲對顱內(nèi)出血尤其室管膜下出血(SEH)和腦室內(nèi)出血(IVH)的分辨率明顯強于CT。2、二維超聲定量顱內(nèi)出血量的方法甚多,當(dāng)前,在臨床上應(yīng)用最廣泛的是1/2abc法和1/3abc。本研究采用公式2/3Sh進行計算。通過對采用105例數(shù)據(jù)的T檢驗和相關(guān)性分析結(jié)果顯示公式2/3Sh和CT計算機輔助的體積分析法(金標準)計算的顱內(nèi)出血量存在較好的相關(guān)性。Pearson相關(guān)分析表明2/3Sh法測定的出血容積和金標準估測數(shù)值具有良好的一致性。3、三維超聲對不規(guī)則容積具有更準確的測定價值,本研究采用三維容積超聲測量顱內(nèi)出血量,結(jié)果表明,三維超聲測定顱內(nèi)出血量與CT計算機輔助的體積分析法(金標準)計算的顱內(nèi)出血量具有更高的相關(guān)性和一致性。Pearson相關(guān)分析表表明3D法測定的出血容積和金標準估測數(shù)值具有更好的一致性。4、對研究對象進行隨訪觀察,腦室內(nèi)室管膜下少量出血、硬膜下血腫以及蛛網(wǎng)膜下出血吸收迅速,一般2~3周基本完全吸收;腦實質(zhì)團塊狀出血、腦室內(nèi)片狀出血吸收緩慢,一般在治療1個月左右出血開始吸收,本組僅2例出血灶在2周內(nèi)吸收正常,大部分病灶在1~3個月完全吸收。5、臨床隨訪表明,超聲診斷顱內(nèi)出血157例患兒中,Ⅰ級、Ⅱ級93例無明顯臨床癥狀或神經(jīng)精神癥狀輕,預(yù)后良好;Ⅲ級37例、Ⅳ級26例表現(xiàn)為不同程度的神經(jīng)精神癥狀,可留下后遺癥,預(yù)后較差,需要進行神經(jīng)系統(tǒng)干預(yù)治療等。室管膜下出血約80例,出血量0.03~1.15 ml,出血主要位于室管膜下;腦室內(nèi)出血不伴腦室擴張13例,出血量0.73~1.86 ml;單純腦室擴張約14例,出血量2.97~9.68 ml,腦積水11例,出血量約7.3ml~15.8ml,腦室空洞性囊腫12例,出血量約8.2~17.4ml,出血位于腦室內(nèi);腦軟化灶26例,出血量約11.21~26.4 ml,出血主要位于側(cè)腦室周圍及腦實質(zhì)。硬腦膜下出血1例,出血量約8.65 ml。將實際隨訪145例顱內(nèi)出血患兒按預(yù)后情況將其分為無后遺癥、輕度后遺癥、中度后遺癥、重度后遺癥五組。其中無后遺癥組87例,主要為Ⅰ級、Ⅱ級出血、硬膜下出血;輕度后遺癥15例,主要為Ⅱ級、少量Ⅲ級出血;中度后遺癥27例,主要為Ⅲ級、Ⅳ級,重度后遺癥16例,主要為Ⅳ級及腦實質(zhì)內(nèi)出血。結(jié)論1、超聲具有無放射線損害、安全、價廉、方便、無創(chuàng)傷、可進行床旁檢查及動態(tài)追蹤觀察等優(yōu)點,尤其對于早產(chǎn)兒,可作為常規(guī)篩查和隨訪的首選影像學(xué)診斷方法。2、與二維超聲相比,三維容積超聲能全面反映顱內(nèi)出血形狀和周邊腦組織的空間立體關(guān)系,其定量出血量的準確性高于二維超聲法。3、對新生兒顱內(nèi)出血進行早期定性和定量診斷,對新生兒顱內(nèi)出血的預(yù)后判斷具有較大的臨床價值。
[Abstract]:Background neonatal intracranial hemorrhage is the most common and most important neurological disease in neonates. Massive bleeding can cause serious consequences, especially for premature infants, which is one of the important causes of neonatal nervous system death and developmental disorders. Therefore, the early diagnosis of intracranial hemorrhage in the newborn appears to be particularly important. Not only to the diagnosis and treatment of clinicians to provide effective information to guide the effective and reasonable treatment, to lay the foundation for good prognosis, which can improve the cure rate, to reduce the sequela of the nervous system plays a particularly important role. Therefore, the in-depth study and understanding of these problems will be very beneficial to improve the clinical diagnosis and treatment technology and level. Ultrasound is a technology to understand human tissue structure and its corresponding pathological process by using its acoustic characteristics. B ultrasound is a two-dimensional imaging displayed in gray scale on the screen in real time. In the late 1970s, the diagnostic technology of ultrasound began to be applied in the diagnosis of neonatal intracranial diseases in the neonatal field. With the further improvement of imaging technology, the field of vision of ultrasound diagnosis was broadened, and the changes of ventricles, lacunar structures and brain parenchyma could be clearly displayed. With the rapid development of computer technology in 1980s and the maturity of three-dimensional ultrasound imaging technology, Nagdyman used the three-dimensional ultrasound to detect neonatal brain anatomy structure for the first time since 1999, and opened up a new field of three-dimensional ultrasound application. Three-dimensional ultrasound can be used to accurately locate the relationship between the lesions of the brain and the surrounding tissues, the size of the lesions and the volume measurement. The newborn was born because the fontanels have not yet closed, fontanelle through the window of good, not only can obtain good imaging effect, and provide favorable conditions for the diagnosis of neonatal intracranial diseases. The ultrasound can detect intracranial hemorrhage, and can show the exact position of hemorrhage, and accurately understand the progression of intracranial hemorrhage and severity, especially to be moved, the rescue of critically ill children, can not leave the warm box, such as the neonatal neonatal ventilator is not convenient for CT, use MRI to check special equipment, CT M RI, because the need to move with CT radioactive, MRI is expensive, big noise and check the time-consuming, not suitable for repeated review, and the thickness of the fault CT and MRI examination is often difficult to find the subependymal and intraventricular hemorrhage group and smaller defects, ultrasound has the advantages of low price and no X-ray damage, non-invasive, convenient, real-time, safe and fast imaging speed and repeatable bedside examination and any dynamic observation in children with the disease progress and other unique advantages, It can be widely used in continuous dynamic monitoring of neonatal intracranial hemorrhage. It has a very important clinical guiding value for early diagnosis and treatment of neonatal intracranial hemorrhage, reducing sequelae that may be left behind, and reducing neonatal mortality. If the qualitative and quantitative diagnosis of intracranial hemorrhage in the newborn can be carried out early, the scientific and effective diagnostic basis can be provided more accurately and timely. However, previous studies focused on the qualitative diagnosis of intracranial hematoma, less quantitative study, and more rare quantitative analysis of the relationship with the prognosis of children. Objective to investigate the value of ultrasound (1) qualitative diagnosis of neonatal intracranial hemorrhage; intracranial hemorrhage (2) accuracy analysis of two-dimensional ultrasound quantitative; (3) to investigate the quantitative analysis of the impact on the children with three-dimensional ultrasound pre analysis after the feasibility and accuracy, and the amount of bleeding quantitative intracranial hemorrhage. Methods a case from Tai'an maternal and child health hospital from January 2013 to 2013 12, was hospitalized in the neonatal department of our hospital. Meanwhile, 200 neonates diagnosed with intracranial hemorrhage were diagnosed by ultrasound and CT examination. The gestational age (26-41 weeks) was 0~31d, with an average age of 8D. There were 110 males and 90 females, including 80 premature infants. The ultrasonic instruments used were PHILS- super, Philipsiu22 color ultrasonic diagnostic apparatus, frequency 5~7.5MHz, small probe of high frequency convex array and fan-shaped scanning. The clinical suspicion of nervous system disease or intracranial hemorrhage patients by two-dimensional ultrasound after anterior coronary and sagittal scanning, preliminary screening of intracranial structures, and brain CT to confirm the diagnosis and screening of intracranial hemorrhage cases, comparative study of different methods. Two dimensional ultrasound mainly observed the structure of the intracranial midline, ventricle size, choroid plexus echo intensity, and the echo of the parenchyma of the brain. Three dimensional volume probe was used to collect the three dimensional data of the bleeding site, and the volume of blood volume was analyzed by three-dimensional ultrasound. The intracranial hemorrhage was detected by cranial CT examination. The accuracy of quantitative bleeding was analyzed by CT quantitative analysis of intracranial hemorrhage volume as standard control. All patients were followed up to analyze the relationship between the site of bleeding, the amount of bleeding and the prognosis of the children. Results 1 and two dimensional ultrasound could clear the hemorrhage of the subdural hemorrhage, intraventricular hemorrhage, partial cerebral hemorrhage and large subdural hemorrhage in the diagnosis room. The highest resolution of the central craniocerebral hemorrhage. It is difficult to diagnose the bleeding of small subdural hemorrhage, subarachnoid hemorrhage, intraderebellar hemorrhage, posterior cranial fossa and other craniocerebral hemorrhage. The resolution of intracerebral hemorrhage (SEH) and intracerebral hemorrhage (IVH) was better than that of CT by ultrasound. 2, two dimensional ultrasound quantitative method of quantitative quantitative intracranial hemorrhage, the most widely used in the clinic is the 1/2abc method and 1/3abc. In this study, formula 2/3Sh is used to calculate. The results of T test and correlation analysis of 105 cases showed that there was a good correlation between the formula 2/3Sh and CT computer aided volume analysis (gold standard) for calculating the amount of intracranial hemorrhage. Pearson correlation analysis shows that 2/3Sh method
【學(xué)位授予單位】：泰山醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R743.34;R445.1

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