脑瘫患儿口运动与进食和营养问题

Oral motor dysfunction, feeding problems and nutritional status in children with cerebral palsy

目的 分析脑瘫患儿口运动与进食障碍的发生率与症状学 ,并对营养状况进行初步评价。方法 2 0 0 2年 3月～ 2 0 0 3年 3月住院康复的脑瘫患儿 5 9例 ,男 39例 ,女 2 0例 ,平均年龄 31个月 (2 0～ 72个月 )。父母问卷调查了解高危因素、喂养史 ,神经病学检查评价脑瘫类型 ,Gesell发育评分评价运动发育年龄 ,测体重、身高评价营养状况 ,对所有患儿进行口运动与进食技能评分与现场观察 ,按年龄、性别匹配对照组进行对比分析。结果 5 9例患儿中口运动障碍 5 1例 ,所有徐动型和痉挛型四肢瘫、16例痉挛型双瘫患儿存在口运动异常 ,脑瘫组平均口运动评分为 (2 5± 15 )分 ,低于对照组儿童 (t=11 5 87,P <0 0 0 1)。口运动异常涉及下颌、唇、舌的各个运动测试亚项。 5 5例患儿存在进食方面问题 ,绝大多数患儿进食过程中需要家长帮助 ,半数患儿仅能进食流质和 (或 )半流质 ,不能进食固体食物。进食技能障碍主要表现在口相和口前相 ,脑瘫组进食技能分平均 (35± 11)分 ,亦明显低于对照儿童 (t=4 5 5 2 ,P <0 0 0 1) ,徐动型总分较低 ,其次是痉挛型四肢瘫。脑瘫组 13例患儿体重低于第 2 5百分位数 ,19例患儿身高低于第 2 5百分位数 ,提示体格发育存在受阻现象。结论 绝大多数脑瘫患儿存在口运动和进食障碍 ,

Objective This study was unde rtaken to investigate the clinical features of oral motor dysfunction and feedin g problems as well as the nutritional status of children with cerebral palsy (CP ). Methods Fifty-nine CP children, 39 boys and 20 girls , mean age 31 months (20 to 72 months), were recruited. Their parents were inte rviewed for high risk factors and feeding history. Each case was assessed for o ral motor and feeding problems based on oral motor and feeding skill score; for nutritional status by measurement of weight, height; neurologically for type of cerebral palsy and for developmental age by Gesell′s developmental scale. Equal number of age and sex matched controls were included for comparison of nut ritional status, oral motor and feeding skill score. Results Among 59 patients, 51 cases had oral motor dysfunction and 55 cases had fee ding problems including all athtosis, spastic tetraplegia, and 16 had spastic di plegia. The scores of both the mean oral motor function and feeding skill of C P children were significantly lower than those of the controls (P<0.001). Main food of children with cerebral palsy consisted of liquid and semisolid diet . Body weight and height below the 25th percentile were found in 13 cases and 1 9 cases, respectively. Conclusions The majority of the c hildren with cerebral palsy had oral motor dysfunction and feeding problems whic h appeared in early age and disturbed the growth and nutritional status. Thorou gh assessment for oral motor function, feeding problems and nutritional status o f CP children is indicated in order to start timely rehabilitation and nutrition al interventions which can significantly improve their nutritional status and qu ality of life. <