早产儿特别是<28周的超未成熟儿,由于脑血管发育不成熟,脑血流自主调节能力较差,极易出现脑血流动力学紊乱,且早产儿神经元、少突胶质细胞及其前体对缺氧缺血异常敏感,耐受性低,易损性高,导致早产儿脑损伤及神经系统后遗症发生率较足月儿高.但临床上早产儿脑损伤往往缺乏明显的神经系统症状和体征,容易漏诊而错过治疗时机.头颅超声、MRI及脑电图均是早产儿脑损伤早期诊断的特殊检查手段.在早期颅内出血诊断上头颅超声优于后两者,但脑白质软化评估则MRI特别是DWI诊断价值最高,而脑电图可在各时期辅助诊断脑损伤患儿,三者各有优劣,临床上若能合理运用三者诊断早产儿脑损伤,则有助于及时发现疾病,尽早治疗,减少早产儿神经系统后遗症的发生,降低致残率,改善远期预后.%The cerebral hemodynamic disorders are most likely to occur in preterm infants, especially in extremely preterm infants with gestational age <28 weeks, due to the immaturity of cerebral vascular development and poor autoregulation of cerebral blood flow. Also the neurons, oligodendrocytes and their precursors in preterm infants are abnormally sensitive to hypoxia and ischemia with low tolerance and high vulnerability, which lead to a higher incidence of brain damage and neurological sequelae in preterm infants than that in full-term infants. Because brain injury in the premature often lacks the obvious nervous system symptom and the sign clinically, it is easy to be misdiagnosed and hence suitable treatment opportunity is missed. Cranial ultrasonography, MRI and EEG are the special examinations for early diagnosis of brain injury in preterm infants. In the diagnosis of early intracranial hemorrhage, cranial ultrasonography is superior to both MRI and EEG, but MRI especially DWI has the highest diagnostic value in the evaluation of leukoencephalomalacia, and EEG plays a supporting role in diagnosis of brain injury in each period. The three techniques have their own advantages and disadvantages. In clinical practice, if three techniques can be rationally used for the diagnosis of brain damage in preterm infants, it would be helpful to detect the disease in time and treat appropriately as soon as possible, and thus reduce the neurological sequelae and disability in preterm infants, and improve the long-term prognosis.
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