围产高危儿神经发育纵向监测临床研究

Clinical Study on Longitudinally Monitored Neurological Development in High Risk Perinatal Infants

目的 探讨高危儿脑损伤早期诊断及康复治疗的方法 ,改善高危儿预后及降低脑瘫发生率。方法 对 6 80例高危儿进行 0～ 12个月神经发育监测、评价 ,神经发育异常患儿进行脑损伤诊断及康复治疗。监测采用Ameil Ti son 1岁内神经运动检查法 (Ameil Tison法 )逐月进行。康复治疗以运动功能训练为主 ,教会家长 ,逐月检查并调整方案。结果 6 80例高危儿中 ,检出脑损伤患儿 2 2 9例 (占 33.6 8% ) ,检出中枢神经协调障碍 (CCD)患儿 2 0 7例 ,达30 .4 4 % ,脑瘫 (CP)患儿 2 2例 ,达 3.2 4 %。均在生后 6个月内出现神经发育异常表现 ,其中 16 9例在生后 3个月内出现神经发育异常 16 9例 (占 73.8% )。经系统监测并系统康复治疗的患儿 2 2 2例 ,CCD患儿 2 0 7例 ,1岁时完全正常 ,治愈率 10 0 % ;CP患儿 15例 ,13例 1岁时完全正常 ,治愈率 86 .6 6 % ,2例 1岁时明显好转 ,系统监测并间断康复的CP患儿 2例 ,1岁时明显好转 ,未系统监测 (经常失访 )并未康复治疗的CP患儿 5例。结论 Ameil Tison法可以有效检出高危儿神经发育异常 ,系统监测可以早期和超早期诊断脑损伤 ,系统监测并系统康复治疗效果显著 ,但失访者脑瘫发生率高且严重 。

Objective To explore possibilities of early diagnosis of brain injuries in high risk infants and their rehabilitation.Methods Six hundred and eighty high risk infants were monitored and assessed the neurological development, by using Ameil Tison approach.Results Two hundred twenty nine infants were detected with brain injuries within 6 months after birth, accounting for 33.68% of the total.Among them 169 developed neurological development abnormalities within 3 months, accounting for 73.80% of the sufferers;207 subjects were detected with CCD,accounting for 30.44% of the total,22 with CP,3.24%.Of all subjects,222 of the neurological development abnormality sufferers and 207 CCD bearers who underwent systematic examination and rehabilitation therapy all turned well by the time they reached one year with recovery rate of 100%;13 of the 15 CP sufferers recovered and recovery rate was 86.66%.The 5 CP sufferers who missed examinations and rehabilitation therapy developed typical CP symptoms by one year of age.Conclusion Ameil-Tison approach is effective in detecting neurological development abnormalities in high risk infants;Systematic longitudinal monitoring and examining facilitates early diagnosis so that rehabilitation therapy may ensue.Those high risk infants who are not closely monitored are highly prone to palsy and treatment would be difficult.