目的：围生期缺氧可致新生儿脑损伤。该文探讨头颅CT对新生儿缺氧后脑损伤程度判断的作用。方法：收集有缺氧过程的足月新生儿114例,分为HIE组、窒息组、窘迫组;取同期正常新生儿20例为对照组,于生后2~7d做头部CT检测及NBNA评分。结果：HIE组、窒息组、窘迫组、对照组NBNA评分异常率及组间NBNA评分分值比较差异有显著性(均P<0.05)。4组间CT异常率比较及HIE组与其他3组CT异常率比较差异有显著性(均P<0.01),对照组、窘迫组、窒息组之间两两比较CT异常率没有差异(均P>0.05)。HIE组25例患儿中,临床分度为轻度HIE15例,中度HIE6例,重度HIE4例。CT分度为正常3例,轻度10例,中度7例、重度5例。HIE的CT分度与临床分度不完全吻合。CT对于轻、中、重度HIE诊断的灵敏度分别为47%,33%,50%,特异度为70%,74%,86%,准确度为48%,64%,80%。结论：头颅CT对HIE临床分度的判断存在不确定性,对宫内窘迫、窒息所致轻微脑损伤的判断更无把握。

OBJECTIVE: To investigate the role of cerebral computed tomography (CT) in the evaluation of the severity of brain injury following hypoxia in neonates. METHODS: A total of 114 full-term newborns who had perinatal hypoxia, including 25 cases of hyoxic-ischemic encephaloathy (HIE), 36 cases of neonatal asphyxia and 53 cases of simple intrauterine fetal distress, were enrolled in this study. Twenty normal newborns served as the Control group. All had cerebral CT scan at 2-7 days of age. Neonatal behavior neurological assessment (NBNA) was performed at 5 days of age. RESULTS: The average NBNA scores were significantly lower and the abnormality rate of NBNA was significantly higher in the HIE group than in the other three groups (P<0.05). The Asphyxia and the Distress groups had also lower NBNA scores and higher abnormality rate of NBNA than the Control group (P<0.05). Twenty-two patients were found to have cerebral CT abnormality in the HIE group, but there was only 1 case in the Control group (P<0.01). The abnormality rate of cerebral CT in the Asphyxia and the Distress groups was not statistically different from that of the Control group. Twenty-five cases of HIE were divided into mild (n=15), medium (n=6) and severe (n=4) by clinical grading but were divided into normal (n=3), mild (n=10), medium (n=7) and severe (n=5) by CT grading. CT and clinical grading on HIE was not consistent. The sensitivity of CT in the diagnosis of mild, moderate and severe HIE was 47%, 33% and 50% respectively, the specificity was 70%, 74% and 86% respectively and the accuracy was 48%, 64% and 80% respectively. CONCLUSIONS: CT evaluation on mild brain injury induced by asphyxia or intrauterine fetal distress is not of any value and the role of CT evaluation on the HIE grade is uncertain and doubtful.