围产期脑性瘫痪危险因素的干预效应分析:6个月随访结果

Effect of intervention on the risk factors of cerebral palsy at perinatal period 6-month follow-up

目的:总结造成脑性瘫痪的高危因素,分析治疗结果与上述高危因素的关系。方法:①选择2002-01/2004-12以各种存在围产期脑损伤或脑性瘫痪高危因素于华中科技大学同济医学院附属协和医院就诊及本院妇产科转诊的新生儿、6月以内的婴儿254例,男150例,女104例。监护人同意参加。②由专科医师对每个病例进行询问式高危因素调查,调查内容包括①宫内因素:早产儿、小于胎龄儿。②产时因素:窒息、颅内出血。③产后因素:外部性脑积水等之一或以上者。对有生长发育落后的患儿进行医学干预,包括静脉应用脑蛋白水解物,高压氧舱、按摩及家庭干预:①讲解脑损伤后神经修复的可塑性理论,强调家庭干预治疗的重要性,让监护人认真完成家庭干预。②声音刺激。③视觉刺激。④触觉刺激。⑤运动功能训练。⑥认知功能训练。⑦语言训练。对存在高危因素,但尚无明显发育落后者,强调家庭干预,进行医学观察,每个月于本院专科门诊随访1次,持续6个月。描述性结果以百分比形式表示。结果:小儿254例均进入结果分析,专科门诊随访6个月。①186例患儿(73.2%)趋于正常;49例(19.3%)仍有中枢协调障碍,19例(7.5%)出现脑瘫典型临床表现。②危险因素观察结果中>35周的早产儿、轻度窒息、外部型脑积水等脑性瘫痪发生率分别为2.7%和0,3.8%,经治疗趋于正常化的好转率为94.6%,95.2%,88.5%。③<32周患儿经干预后6个月时随访,脑性瘫痪发生率为早产儿8.3%,重度窒息儿16.1%,颅内出血儿30.0%。结论:<32周的早产儿、小于胎龄儿、重度窒息、颅内出血为脑性瘫痪的主要高危因素,干预效果较差。

AIM： To summarize the high-risk factors leads to cerebral palsy, and analyze the association between the therapeutic outcomes and the high-risk factors. METHODS： Totally 254 neonates and infants within 6 months after birth （150 males and 104 females） with various high risk factors of perinatal cerebral injury or cerebral palsy, who were hospitalized in the Department of Obstetrics and Gynecology, Union Hospital affiliated to Tongji Medical College, Huazhong University of Science and Technology from January 2002 to December 2004, were involved in the study with the permission of their guardians, studied. （2） The high-risk factors of each case were surveyed by the professional physicians with the inquiring methods, the contents were ① Intrauterine factors： premature or infants small for gestational age; ②intrapartum factors： asphyxia and intracranial hemorrhage; ③ postpartum factors： external hydrocephalus. The infants with developmental retardation were given medical interventions, including venous injection of brain albumen hydrolysate, hhperbaric oxygen chamber, massage and family intervention： ① illustrating the plasticity theory of neural repair after cerebral injury, emphasizing the importance of family intervention to promote the guardians to finish the family intervention carefully. ② sound stimulation.③ visual stimulation. ④ tactile stimulation.⑤ motor function training.⑥ cognitive function training.⑦ language training. For the infants with high-risk factors but without obvious devdopmental retardation, family intervention was emphasized, medical observation was given, and followed up in the special clinic of our hospital every month for 6 months.The descriptive results were expressed as percentage. RESULTS： All the 254 infants were involved in the analysis of results, and they were followed up for 6 months in the special clinic. ① 186 cases （73.2%） tended to normal, 49 cases （19.3%） still had central coordination disorder, 19 cases （7.5%） had representative clinical manifestations of cerebral palsy. ② The observational outcomes of the risk factors showed that the incidence rate of cerebral palsy in the prematures 〈 35 weeks, infants with mild asphyxia and external hydrocephalus was 2.7%, 0% and 3.8% respectively, the rates of turning better that tended to normal after treatment were 94.6%, 95.2% and 88.5%. ③ At the 6-month follow-up after intervention, and the incidence rate of cerebral palsy in the prematures （ 〈 32 weeks）, infants with severe asphyxia and intracranial hemorrhage was 8.3%, 16.1% and 30.0% respectively. CONCLUSION： The main high-risk factors of cerebral palsy were prematures 〈 35 weeks, infants small for gestational age, severe asphyxia and intracranial hemorrhage, and the interventional effects are worse.