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新生儿脑病的病因及发病机制

Authors
Sidhartha Tan, MD
Yvonne Wu, MD, MPH
Section Editors
Douglas R Nordli, Jr, MD
Leonard E Weisman, MD
Deputy Editor
John F Dashe, MD, PhD
Translators
李晓瑜, 副主任医师，副教授

引言

新生儿脑病(neonatal encephalopathy, NE)是一种异质性综合征，以出现新生儿中枢神经系统功能障碍征象为特征。任何表现出意识水平异常、癫痫发作、肌张力和反射异常、呼吸暂停、误吸、喂养困难[1,2]和听力筛查异常的婴儿均应考虑临床疑诊NE。

本专题将总结NE的病因及发病机制。该综合征的其他临床方面将单独讨论。 (参见“新生儿脑病的临床特征、诊断及治疗”)

专业术语

NE已成为描述新生儿期中枢神经系统功能障碍的首选术语[2,3]。美国妇产科医师学会(American College of Obstetricians and Gynecologists,ACOG)将NE描述为一种从临床上定义的综合征，其特点是35周或以上胎龄时出生的新生儿在出生后早期出现神经系统功能障碍，表现为意识水平下降或癫痫发作，常伴有启动和维持呼吸困难，以及肌张力和反射的减弱[4]。

该专业术语并不提示一种特定的潜在病理生理学表现，这种观点是恰当的，因为引起新生儿神经功能缺损的脑损伤的性质还很不清楚。NE曾被自然而然地归因于缺氧缺血[5]，但现在人们认识到，缺氧缺血仅仅是NE众多可能的促发因素之一。某一特定的NE能否归因于缺氧缺血性脑损伤常不清楚。

部分研究者要求需满足严格的标准才能采用NE这一术语，如2个或以上的脑病症状持续超过24小时[6]，而其他研究者只要求低的5分钟阿普加评分[7]。然而，仅使用阿普加评分是有问题的，因为阿普加评分可因母体镇痛或婴儿早产而出现评分较低，或者它可在急性缺氧缺血损伤时评分正常。

                 

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Literature review current through: 2017-06 . | This topic last updated: 2016-03-10.
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