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新生兒囟門凹陷該怎么辦？

出處：網(wǎng)絡(luò)收集日期：2024-07-11 14:19:09編輯：秩名

囟門凹陷是怎么回事

囟門指嬰兒出生時頭頂有兩塊沒有骨質(zhì)的“天窗”，醫(yī)學(xué)上稱為“囟門”。后囟門一般在出生后3個月閉合，前囟門要到1歲半才閉合。人們常說的“天窗”或“囟門”主要是指前囟門。囟門的表面是頭皮，其下面是腦膜，其次是大腦和腦脊液。將手指輕放入在囟門上，可以摸到跳動。那是腦脊椎壓力隨著心臟搏動、血壓變化而變化，與脈搏一致。正常嬰兒坐位時，囟門略微凹陷。
 
顱內(nèi)的腦脊液和身體的血液、組織液不斷交換，保持平衡。當(dāng)身體丟失較多水分時，腦室的腦脊液也會減少，壓力降低，囟門便會明顯凹陷。如嬰兒因嘔吐、腹瀉后出現(xiàn)這種癥狀，說明身體已中等程度的脫水，要及時補充水分，否則，因嬰兒自然調(diào)節(jié)能力差，耐受力不足，可能發(fā)生循環(huán)衰竭，有生命危險；由于喂養(yǎng)不當(dāng)造成重度營養(yǎng)不良的極度消瘦嬰兒也會出現(xiàn)囟門凹陷，此時需加強營養(yǎng)，合理喂著。
 
囟門凹陷下去，最多見于寶寶的身體內(nèi)缺水，如腹瀉后沒有及時補充水分，前囟門由此凹陷下去。這種情況下，需要馬上為寶寶補充液體。
 
為了降低顱內(nèi)壓，使用了大劑量的脫水劑，從而使前囟門因脫水而凹陷。應(yīng)該及時給寶寶的身體補充水分，以防脫水過度造成體內(nèi)代謝紊亂。
 
營養(yǎng)不良、消瘦的寶寶，他們的前囟門也經(jīng)常表現(xiàn)出凹陷現(xiàn)象。
 

囟門凹陷的原因及癥狀

囟門凹陷主要原因是身體缺水，主要有三種程度的脫水狀況：
 
(一)輕度脫水
 
體重減輕5%，囟門出現(xiàn)輕微凹陷。其他癥狀包括面色蒼白，皮膚和黏膜干燥，尿量減少，脈率正?；蚵杂猩?，并可能出現(xiàn)易激惹。
 
(二)中度脫水
 
體重減輕10%，出現(xiàn)更明顯的囟門輕度膨隆伴局部皮膚灰暗、張力下降，黏膜干燥，眼淚和尿量減少?；純貉獕赫；蚪档?，脈率增加，也可能出現(xiàn)嗜睡。
 
(三)嚴(yán)重脫水
 
體重減輕≥15%，可能導(dǎo)致囟門明顯凹陷，皮膚腫脹。皮膚、黏膜干燥，明顯少尿或無尿，嗜睡，且出現(xiàn)休克表現(xiàn)，如脈搏增快但無力、嚴(yán)重低血壓和反應(yīng)遲鈍。
 
如果發(fā)現(xiàn)明顯的囟門凹陷，應(yīng)立即測量生命體征、體重，并檢查有無休克跡象——心動過速、呼吸急促及皮膚蒼白發(fā)冷。如果出現(xiàn)這些跡象，建立靜脈通路，給予補液處理。保證呼吸道通暢，并準(zhǔn)備適合患兒大小的急救設(shè)備、吸氧。并可通過稱重濕尿布來測量尿量。
 
同時從患兒的父母或照顧者那里詳細(xì)詢問病史，尤其注意近期有無發(fā)熱、嘔吐、腹瀉和行為變化。監(jiān)測過去24小時內(nèi)患兒的液體攝入量和尿量，包括尿布內(nèi)的尿量。了解患兒發(fā)病前的體重，并對比目前體重;體重減輕的情況反映患兒失水的狀況。
 

囟門凹陷的治療

嚴(yán)密監(jiān)測患兒的生命體征和出入量，注意有無脫水惡化跡象。進行血電解質(zhì)檢查，了解有無鈉、氯、鉀水平升高或降低。如果是輕度脫水，可少量多次補充清水或提供口服的鹽水。如果患兒不能攝取足夠液體，進行胃腸外靜脈營養(yǎng)。
 
如果患者有中度至重度脫水，首要任務(wù)是迅速補充細(xì)胞外液，以治療或防止休克。持續(xù)給予靜脈補液，并補充碳酸氫鈉以糾正酸中毒。隨著腎功能的改善開始靜脈補鉀。當(dāng)患兒的液體情況逐漸穩(wěn)定后，要開始在飲食中增加脂肪和蛋白質(zhì)攝入。
 
通過相關(guān)化驗檢查了解脫水情況，包括檢測尿比重，血清尿素氮及血清肌酐水平、血液滲透壓和酸堿平衡狀況。
 
總之父母們要知道，寶寶的囟門是一個觀察疾病的窗口，如果囟門飽滿或隆起時，則表示孩子有顱內(nèi)高壓的疾病，如腦膜炎、顱內(nèi)出血、腦瘤等；如果囟門過度凹陷，可能是由于進食不足或長期嘔吐、腹瀉所造成的脫水引起的。爸爸媽媽如果發(fā)現(xiàn)異常，一定要馬上帶孩子到醫(yī)院就醫(yī)，千萬不可拖延誤醫(yī)，最好造成不可挽救的遺憾。

 

囟門閉合的時間

囟門閉合的早遲時衡量顱骨發(fā)育的主要內(nèi)容。閉合過早或過遲均為生長發(fā)育異常的表現(xiàn)。中醫(yī)把囟門突起稱為囟填，囟門凹陷稱為囟陷，囟門遲閉稱為解顱。囟門晚閉多見于佝僂病、腦積水、呆小癥及生長過速的嬰兒。
 
嬰幼兒頭頂?shù)呢堕T一般在12-18個月閉合，囟門的閉合是反映大腦發(fā)育情況的窗口，如果在6個月之前閉合，說明孩子可能小頭畸形或腦發(fā)育不全，在18個月后仍未閉合就屬于太晚了，這樣的孩子可能有腦積水、佝僂病和呆小??；囟門的隆起表示顱內(nèi)壓增高，這種孩子可能得了腦膜炎、腦炎和維生素A中毒；囟門凹陷的孩子則有可能是因為脫水和營養(yǎng)不良。如果囟門關(guān)閉的較早，但只要頭圍還在長，也不必著急。發(fā)現(xiàn)囟門關(guān)閉異常，應(yīng)立即帶孩子去醫(yī)院作進一步檢查。
 
寶寶囟門早閉時，必須測量其頭圍大小。如果頭圍大小低于正常值，可能是腦發(fā)育不良。有些身體正常的寶寶，在5-6個月時，前囟門也僅剩下指尖大小，似乎要關(guān)閉了，其實并未骨化，應(yīng)請醫(yī)生鑒別。
 
囟門遲閉，主要是指寶寶已經(jīng)過了18個月，但前囟門還未關(guān)閉，多見于佝僂病、呆小病。囟門遲閉，有少數(shù)是腦積水或其它原因所致的顱內(nèi)壓增高引起，應(yīng)去醫(yī)院做進一步檢查。
 

囟門要如何護理

對于寶寶的囟門，爸爸媽媽們在護理的時候要注意一些事項，以保護寶寶的囟門，主要有以下幾點：
 
一是給寶寶使用的枕頭一定得柔弱一點的，以為太硬的枕頭如綠豆枕、砂枕很容易是寶寶的頭部變形。
 
二是千萬不能養(yǎng)成寶寶側(cè)向一邊睡覺的壞習(xí)慣，這樣寶寶很同意就會偏頭，頭型會很不好看。爸爸媽媽要經(jīng)常幫助小寶貝翻身，一般而言，寶寶都是比較喜歡光線的，可以通過光線吸引寶寶睡向另一側(cè)。
 
三是最好把家中比較尖銳的家具什么的用柔軟的布料包裹起來，以免寶寶不下心碰到。如果寶寶不慎碰到并且破皮，一定要做好消毒工作，如用酒精棉球進行消毒。
 
四是寶寶要外出的時候，特別是寒冷的冬天，一定要幫寶寶戴上較厚的帽子，這樣可以保護寶寶的囟門，又能夠防寒保暖。
 
五是寶寶的囟門要注意清洗。清洗寶寶囟門的時候不能使用肥皂，而應(yīng)該使用寶寶專用的洗發(fā)液，同時在清洗囟門的時候不能大力按壓和抓撓，而是應(yīng)該輕輕地揉洗。如果寶寶的囟門那有不易清洗的污垢，那么可以先用消毒棉花沾上煉過晾涼的植物油放在寶寶的囟門出，之后再輕輕揭去，清洗干凈擦上嬰兒爽身就好。

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