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[目的]探讨婴儿迟发型维生素K缺乏致颅内出血35例临床特点分析及防治方法。[方法]所有患儿确诊后立即给予维生素K1 5～10 mg静脉,连用3～5 d,重者可输血10～15 ml/kg/次,1次/d,共用l～3 d。颅内压明显增高或反复惊厥者,联合应用甘露醇和地塞米松,并给予镇静剂和其他止血剂以及抗炎、营养支持等疗法。必要时,部分患儿根据症状给予侧脑室穿刺或前囟穿刺放液。急性期后使用神经节苷脂促进神经生长和改善脑血流的药物复方丹参液,对部分有侧脑室扩大者,使用碳酸酐酶抑制剂醋氮酰胺,以减少患儿神经系统后遗症的发生。对所有患儿的临床资料、防治及预后等资料进行统计分析。[结果]本组患儿35例,放弃1例、死亡1例,转院2例,出院1年后随防24例,遗留神经系统后遗症11例。临床表现方面,74.29%患儿面色苍白,65.71%患儿前囟饱满或隆起,37.14%患儿拥抱反射减弱或消失,62.86%患儿注射部位出血,31.42%患儿惊厥抽搐,8.57%患儿意识障碍伴瞳孔不等大,20.00%患儿呕吐,4例患儿血红蛋白32～59 g/L,8例60～90 g/L,23例90～120 g/L。35例患儿CT表现为蛛网膜下腔出血16例,硬膜下血肿9例,脑实质出血7例,脑室内出血3例,混合性出血l0例。并发脑水肿14例,脑疝9例,大面积脑梗死4例。[结论]该病致残率较高,若不积极正确治疗,死亡率高,应早期诊断,合理治疗以降低其死亡率及致残率;对具有患该病危险因素的婴儿,应早期使用维生素K预防。
[Objective] To investigate the clinical characteristics of 35 cases of intracranial hemorrhage caused by delayed vitamin K deficiency in infants and its prevention and treatment. [Methods] All infants were given intravenous injection of vitamin K1 5 ~ 10 mg immediately after diagnosis, and they were given 3 ~ 5 days consecutively. In severe cases, they could transfused blood from 10 to 15 ml / kg once daily for 1-3 days. Significant increase in intracranial pressure or recurrent seizures, combined with mannitol and dexamethasone, and given sedatives and other hemostatic agents and anti-inflammatory, nutritional support and other therapies. When necessary, some children given lateral ventricle puncture or anterior fontanel puncture according to the symptoms. Acute phase after the use of gangliosides to promote nerve growth and improve cerebral blood flow drug compound Salvia Miltiorrhiza, part of the enlarged lateral ventricles, the use of carbonic anhydrase carbonic anhydrase inhibitor, to reduce the incidence of neurological sequelae in children. All children with clinical data, prevention and prognosis and other data for statistical analysis. [Results] 35 cases of this group of children, giving up 1 case, 1 died, 2 cases transferred to hospital, discharged after 1 year with 24 cases of prevention, legacy of neurological sequelae in 11 cases. In terms of clinical manifestations, 74.29% of the children were pale, 65.71% of children had full or bulging anterior fontanelle, 37.14% of children had weakened or disappeared cataract, 62.86% of children had bleeding at the injection site, 31.42% had convulsions and convulsions, 8.57% Disorders of consciousness with pupils ranging from large, 20.00% of children with vomiting, 4 cases of children with hemoglobin 32 ~ 59 g / L, 8 cases of 60 ~ 90 g / L, 23 cases of 90 ~ 120 g / 35 cases of children showed subarachnoid hemorrhage in 16 cases of CT, subdural hematoma in 9 cases, 7 cases of cerebral parenchymal hemorrhage, intraventricular hemorrhage in 3 cases, mixed bleeding l0 cases. Complications of brain edema in 14 cases, 9 cases of cerebral hernia, large cerebral infarction in 4 cases. [Conclusion] The morbidity of this disease is high, if not correct treatment, the mortality rate should be early diagnosis and reasonable treatment to reduce the mortality and morbidity; for those with risk factors of the infant should be used early Vitamin K prevention.