早产儿相关的脑出血后脑积水:我们的机构系列回顾和长期随访

Pablo Miranda , Juan Antonio Simal , Estela Plaza , Giovanni Pancucci , Raquel Escrig , Nuria Boronat , Roberto Llorens
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摘要

引言与早产相关的出血性脑积水是神经系统损伤的主要原因,也是容易出现各种并发症的婴儿脑室-腹腔分流术的常见指征。诊断和治疗方案正在不断演变,需要对其结果进行评估。目的回顾1982年至2020年我院发生的一系列早产相关的出血性脑积水需要明确分流的临床特征和结果。作为次要目标,我们评估了自2015年以来我们的治疗方案变化的安全性。方法回顾性综述,临床调查。结果133例患者在研究期间植入了分流器。15例患者被诊断为分流感染。近端分流梗阻作为第一并发症在一年时诊断为30%,在两年时诊断为37%,在五年时诊断出46%。61名患者在最后一次随访中出现了非常小或塌陷的心室。我们三分之二的患者实现了正常的神经发育或轻度损伤。方案的改变并没有显著改变临床结果,尽管观察到大多数结果都有所改善。平均随访时间超过9年。结论临床结果与以前报道的数据具有可比性。协议的更改被证明是安全的,并改进了我们的结果。可编程分流可以安全地用于早产患者,尽管它们可能不能防止心室塌陷的趋势,而心室塌陷在长期随访后非常常见。
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Preterm-related posthemorrhagic hydrocephalus: Review of our institutional series with a long-term follow-up

Introduction

Preterm-related posthemorrhagic hydrocephalus is a major cause of neurological impairment and a common indication for a ventriculoperitoneal shunt in infants that are prone to diverse complications. Protocols of diagnosis and treatment are in continuous evolution and require evaluation of their results.

Objective

To review the clinical characteristics and results of a series of preterm-related posthemorrhagic hydrocephalus needing a definitive shunt from 1982 to 2020 in our institution. As a secondary objective we evaluated the safety of the changes in our protocol of treatment from 2015.

Methods

Retrospective review, clinical investigation.

Results

133 patients were implanted a shunt in the study period. Shunt infection was diagnosed in 15 patients. Proximal shunt obstruction as the first complication was diagnosed in 30% of cases at one year, 37% at two years and 46% at five years. 61 patients developed very small or collapsed ventricles at last follow-up. Two thirds of our patients achieved normal neurological development or mild impairment. Changes in protocol did not significantly modify clinical results although improvement in most outcomes was observed. Mean follow-up was over nine years.

Conclusions

Clinical outcomes are comparable to previous reported data. Changes in protocol proved to be safe and improved our results. Programmable shunts can be used safely in preterm patients although they may not prevent tendency towards ventricular collapse, which is very common after long follow-up.

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