脑性瘫痪的围产期高危因素:139例回顾性分析

High risk factor of cerebral palsy during perinatal period: a retrospective analysis of 139 cases

目的:脑性瘫痪(cerebralpalsy,CP)是儿科常见的致残性疾病,明确脑性瘫痪发生的高危因素、临床表现特点以及并发症等情况对降低脑性瘫痪发生率,改善患儿预后以及提高生活质量有重要意义。分析139例脑性瘫痪患儿的临床资料特点,探讨脑性瘫痪的围生期高危因素并。方法:对139例脑性瘫痪患儿的围生期高危因素进行回顾性调查,并对脑性瘫痪的诊断年龄、头颅计算机体层摄影(CT)或磁共振成像(MRI)、脑电图改变以及并发癫痫的情况进行分析。结果:139例脑性瘫痪患儿以痉挛型(66.2%)最多见,其次为手足徐动型(18.0%)和共济失调型(5.8%)。111例脑性瘫痪患儿存在围生期高危因素,常见的高危因素依次为新生儿窒息、早产和低出生体质量;77.5%的脑性瘫痪患儿具有2种或2种以上的围生期高危因素。64.8%的脑性瘫痪在6月龄前确诊,22.3%的在3月龄前确诊。84.7%的脑性瘫痪患儿头颅CT和/或MRI异常,常见改变包括脑发育不良(30.5%)、脑积水(21.0%)、脑萎缩(15.2%)等。35.7%的脑性瘫痪患儿脑电图异常,合并癫痫的脑性瘫痪患儿脑电图异常率高达84.4%,并且以典型痫样波出现的比例较高(54.2%);未合并者以背景慢活动为主(61.1%),两组差异有显著性意义(χ2=7.11,P<0.05)。结论:脑性瘫痪的发生与围生期高危因素密切相关。

AIM:Cerebral palsy(CP) is a common disease leading to disability in children,so it is important to grasp the high risk factor of CP episode,the clinical manifestation and the complication for reducing the incidence of CP,improving the prognosis of sick children and the quality of life.In the present study,the clinical data of 139 children with CP were analyzed and the high risk factors during perinatal period investigated.<METHODS:A retrospective analysis was employed in 139 children with CP,including risk perinatal factors,diagnosed ages,brain CT or MRI,features of electroencephalogram(EEG) and complicated epilepsy.<RESULTS:Among the clinical types for the 139 children with CP,66.2% were spasticity,18.0% were athetosis,and 5.8% were ataxia. Perinatal high risk factors were found in 111 cases of CP.The common risk factors during the perinatal period were neonatal asphyxia,premature and low birth body in turn.Seventy seventy point five percent of CP children had two or more perinatal risk factors.Sixty four point eight percent CP were diagnosed in children with the ages of 6 months and 22.3% within 3 months.Neurological abnormalities in CT or MRI of brain,including cerebral dysplasia(30.5% ),hydrocephalus(21.0% ) and cerebral atrophy(15.2% ),were found in 84.7% CP children.Abnormal EEG was found in 35.7% children with CP,including 84.4% complicated with epilepsy.Typical epileptiform waves presented in 54.2% CP children complicated with epilepsy and slow background waves activities in 61.1% CP children without epilepsy.There were significant differences between the two groups(χ 2=7.11, P< 0.05).<CONCLUSION:The occurrence of CP is closely related with the high risk factors during the perinatal period.Multiple factors can increase the incidence of CP.Most CP can be diagnosed in children less than 6 months of age.The abnormal rates of brain CT or MRI and EEG electroencephalogram are higher in children with CP,which is helpful in determining the etiology and prognosis of CP.