Bulas D I, Taylor G A, O'Donnell R M, Short B L, Fitz C R, Vezina G
Department of Diagnostic Imaging and Radiology, Children's National Medical Center, Washington, DC, USA.
AJNR Am J Neuroradiol. 1996 Feb;17(2):287-94.
To determine the frequency of intracranial lesions in infants treated with extracorporeal membrane oxygenation (ECMO), to evaluate trends in frequency during an 8-year period, and to determine which infants are at highest risk for intracranial injury.
Daily sonograms were obtained in 386 infants during treatment with ECMO. Cranial CT scans were acquired after decannulation in 286 of 322 survivors. Abnormalities were classified as major or minor and hemorrhagic or nonhemorrhagic. Results were correlated with infant demographic data.
Intracranial abnormalities were detected in 203 (52%) of the 386 infants; 73 (19%) hemorrhagic, 86 (22%) nonhemorrhagic, and 44 (11%) combined lesions. Eighty-two lesions (21%) were classified as major. Forty-six (94%) of 49 major hemorrhages were identified at sonography. CT contributed additional information in 73% of neonates with intracranial abnormalities, of which 17 were major lesions not identified at sonography. The frequency of intracranial hemorrhage was increased in infants who were septic or premature or weighed less than 2.5 kg. An increase in time spent on ECMO bypass increased the risk for nonhemorrhagic injury. During an 8-year period, the frequency of hemorrhagic and major nonhemorrhagic lesions remained constant, whereas minor nonhemorrhagic abnormalities increased significantly.
Infants treated with ECMO continue to be at high risk for cerebrovascular injury. Although daily sonograms are useful in identifying major hemorrhages, follow-up CT scans are crucial for accurate evaluation of intracranial abnormalities.
确定接受体外膜肺氧合（ECMO）治疗的婴儿颅内病变的发生率，评估8年间发生率的变化趋势，并确定哪些婴儿发生颅内损伤的风险最高。
对386例接受ECMO治疗的婴儿进行每日超声检查。322例幸存者中有286例在拔除插管后进行了头颅CT扫描。异常分为严重或轻微、出血性或非出血性。结果与婴儿人口统计学数据相关。
386例婴儿中有203例（52%）检测到颅内异常；73例（19%）为出血性，86例（22%）为非出血性，44例（11%）为混合性病变。82例病变（21%）被分类为严重。49例严重出血中有46例（94%）在超声检查中被发现。CT为73%有颅内异常的新生儿提供了额外信息，其中17例为超声检查未发现的严重病变。脓毒症、早产或体重小于2.5 kg的婴儿颅内出血发生率增加。ECMO体外循环时间增加会增加非出血性损伤的风险。在8年期间，出血性和严重非出血性病变的发生率保持不变，而轻微非出血性异常显著增加。
接受ECMO治疗的婴儿仍然面临脑血管损伤的高风险。尽管每日超声检查有助于识别严重出血，但后续CT扫描对于准确评估颅内异常至关重要。
