文档介绍：新生儿颅内出血 IntracranialHemorrhage oftheNewbornDepartmentofpediatrics陈平洋中南大学儿科学教研室第七章第七节目的与要求Tobefamiliarwithetiology(病因),pathogenesis(发病机制)andprognosis(预后)Tomasterclinicalmanifestation(临床表现)Tomasterdiagnosis(诊断)andtreatment(治疗)病因与发病机制 (Etiologyandpathogenesis)1、产伤性(birthtrauma)颅内出血常见于下列情况:巨大儿(macrosomia)、头盆不称(cephalopelvicdisproportion)、使用吸引器(vacumassisted)或产钳(forceps)助产。常见的颅内出血类型:硬膜下出血(subduralhemorrhage,SDH)、蛛网膜下腔出血(subarachnoidhemorrhage,SH)2、缺氧缺血性(hypoxic-ischemic)颅内出血毛细血管内皮细胞受损血管通透性增加或破裂出血。脑血管自主调节功能受损压力被动性脑血流(pressurepassivecirculatory)形成出血。<32周的早产儿胚胎生发层基质(germinalmatrix)脑室周围-脑室内出血(periventricular-intraventricularhemorrhage,PVH-IVH)3、医源性颅内出血过多搬动婴儿输注高渗液体输液过快血压急剧上升出血频繁吸引气胸Clinicalmanifestation(临床表现)Consciousdisturbance(意识障碍)先兴奋,后抑制:lethargy(嗜睡),coma(昏迷)Increasedintracranialpressure(颅内高压)enlargingheadcircumference(头围增大),bulgingfontanel(囟门凸起)Breathingdisorder(呼吸障碍)apnea(呼吸暂停),cyanosis(发绀)ClinicalmanifestationAbnormaleyesignsgaze(凝视),poorlightreflex(对光反射迟钝)Musculartension(肌张力)早期增高,以后减低Primaryreflex(原始反射)weakorabsent无原因可解释的黄疸和贫血Diagnose(诊断)History(病史)birthtrauma,asphyxiaManifestationencephalopathy(脑病)ExaminationCSF:RBCorshrunkenerythrocyte(皱缩红细胞)CTultrasonography(超声波检查法))Abrasions(擦伤)hymoses(瘀斑)(头颅血肿)Intracranialhemorrhage