早产儿轻症脑白质损伤穴位抚触治疗前后影像学分析

摘要

目的 探讨颅脑彩超与磁共振在轻症早产儿脑白质损伤后的穴位抚触治疗前后的影像学改变及其临床意义.方法 住院期间确诊轻度脑白质损伤的早产儿分为穴位抚触组和对照组,各15例.家长经培训,出院后每日对早产儿进行早期抚触干预.在纠正年龄3月、6月、9月及1岁龄时行颅脑彩超检查;3月、1岁龄时行头颅MR与颅脑彩超比较,并进行相关临床随访.结果 早产儿脑白质损伤以Ⅰ级、Ⅱ级为多.颅脑彩超异常者:两组3月龄见小囊肿,6月龄、9月龄见局部脑室扩大、脑沟回加深,对照组明显.1岁龄因前囟近闭未行超声检查.MRI检查异常者:两组3月龄见小囊肿,1岁龄见脑室扩大、脑室周围白质减少,对照组除上述异常外还可见胼胝体变薄.临床追踪,颅脑超声或MRI显示有颅内异常改变的早产儿有临床表现.结论 颅脑超声对早产儿脑白质损伤敏感性高,直观价廉、可重复,在疾病早期及中期可确诊本病及评估干预治疗后颅内改善情况;MRI对本病晚期有特征性表现,可做后期随访及评估.及早穴位抚触干预治疗轻症脑白质损伤的早产儿,可改善其预后.%Objective To investigate the imaging changes and clinical significance of cerebral ultrasound and magnetic resonance imaging (MRI) in mild cerebral white matter injury of premature infants before and after treatment of acupoint touch.Methods Premature infants diagnosed as mild cerebral white matter injury in our hospital were divided into acupoint touch group and control group with 15 cases in each group.In the early stage,daily touching intervention on premature infants were given by parents after training.Premature infants underwent cerebral ultrasound in correct gestational age of 3 months,6 months,9 months,and 1 year,compared with MRI examination in 3 months and 1 year.In addition clinical results were followed up.Results Most of the cerebral white matter injury in premature infants was class Ⅰ and class Ⅱ.Cerebral ultrasound was unusual:small cysts were found in 3-month-premature infants,local ventricular expansion and deepening brain circuitry were found in those of 6 months and 9 months in both groups,however,control group presented more obviously.Since the anterior fontanelle was nearly closed in premature infants of 1 year old,ultrasonic examination was waived.MRI examination was abnormal:small cysts were found in premature infants of 3 months,ventricle enlargement and reduced ventricle surrounding white matter were found in premature infants of 1 year old in both two groups.Besides,the thinning of corpus callosum was found in control group.Intracranial abnormal changes in premature infants showed by cerebral ultrasound or MRI had corresponding clinical manifestation during clinical followup.Conclusions Cerebral ultrasound is highly sensitive,intuitionistic,repeatable,with inexpensive price in premature infants with cerebral white matter injury.It can diagnose this disease in early and middle stage,as well as evaluate the intracranial improvement after intervening therapy.MRI has a characteristic performance in the advanced stage,therefore the late follow-up and assessment is available.Early interventional treatment of acupoint touch can improve the prognosis in premature infants with mild cerebral white matter injury.