Stephani U, Harms K, Herting E, Speer C P
Kinderklinik, Universität Göttingen.
Monatsschr Kinderheilkd. 1989 Apr;137(4):218-24.
Following perinatal asphyxia and intracranial hemorrhage frequently progressive ventricular dilatation develops in preterm infants. Most common is communicating hydrocephalus due to obliterative arachnoiditis. Ventricular dilatation is reported to affect normal brain development and early therapy is recommended. Cerebrospinal fluid shunting is still accompanied by multiple complications, esp. in preterm infants with a birth-weight below 1,500 g. Seven preterm infants, born between the 27th and 34th gestational week with a birthweight of 910-1,940 g were medically treated for their progressive communicating hydrocephalus. The therapy consisted of intermittant lumbar punctures, medication of acetazolamide and furosemide as well as electrolyte and base replacement. Therapy was started at the 14th-31st postnatal day and lasted from 46 to 149 days. In all children the ventricular dilatation diminished. A steady state of cerebrospinal fluid production and absorption was regained in four children. Due to reoccurrence of ventricular dilatation shunting was performed in three others at the age of more than 3 months and with a weight of 3,620-5,170 g. Thus, medical therapy of hydrocephalus provides time for development of preterm infants, delay of shunting procedures and normalisation of cerebrospinal fluid dynamics.
围产期窒息和颅内出血后，早产儿常出现进行性脑室扩张。最常见的是由于蛛网膜粘连性炎症导致的交通性脑积水。据报道，脑室扩张会影响正常脑发育，因此建议尽早治疗。脑脊液分流术仍伴有多种并发症，尤其是出生体重低于1500克的早产儿。7例孕27至34周出生、出生体重910 - 1940克的早产儿因进行性交通性脑积水接受了内科治疗。治疗方法包括间歇性腰椎穿刺、乙酰唑胺和呋塞米药物治疗以及电解质和碱替代。治疗于出生后第14至31天开始，持续46至149天。所有患儿的脑室扩张均减轻。4例患儿恢复了脑脊液产生和吸收的稳定状态。另外3例患儿因脑室扩张复发，在3个月以上、体重3620 - 5170克时接受了分流术。因此，脑积水的内科治疗为早产儿的发育争取了时间，推迟了分流手术，并使脑脊液动力学恢复正常。
