缺氧缺血性脑病新生儿12月龄时智力、运动发育水平随访研究

Study on Follow-Up of Mental and Physical Development for 12 Months Old Infants with Hypoxic-Ischemic Encephalopathy

目的探讨缺氧缺血性脑病(HIE)对婴儿智力、运动发育的影响,为临床早期干预提供理论依据。方法对2005年3月-2006年3月西安交通大学医学院第一附属医院儿科住院确诊的42例HIE患儿(HIE组)和同期出生的80例健康婴儿(健康对照组),均于12个月±7d时回院随访,内容包括婴儿体格营养发育状况评估、人口社会学资料收集,采用贝利婴幼儿发展量表测评智力发展指数(MDI)和运动发展指数(PDI),进行二组MDI、PDI粗分、标准分、程度及具体条目进行比较,分析智力及运动发展影响因素。结果HIE组、健康对照组MDI粗分和标准分与健康对照组比较均有统计学差异(t=2.74,2.99Pa<0.05),PDI粗分和标准分与健康对照组比较均无统计学差异(t=0.12,0.77Pa>0.05);HIE组、健康对照组MDI标准分≥120分、80～119分、≤79分例数二组比较差异有统计学意义(χ2=12.04P<0.05),PDI标准分≥120分、80～119分、≤79分例数二组间差异无统计学意义(χ2=0.33P>0.05);HIE组患儿对外界反应能力、记忆能力、解决问题能力、语言能力、概括和分类能力的通过率均低于健康对照组,其中记忆能力和解决问题能力二组比较差异有统计学意义(χ2=5.84,5.20Pa<0.05);HIE组患儿粗大运动、手的精细运动、动作的协调性通过率均低于健康对照组,仅手的精细运动二组比较差异有统计学意义(χ2=5.40P<0.05)。结论HIE对婴儿智力、运动的发展有影响,其对智力的影响主要表现在记忆能力和解决问题能力二方面,对运动的影响主要表现在手的精细运动方面。

Objective To investigate the influence of hypoxie- isehemie eneephalopathy（HIE） on mental and physical development and provide theoretical basis for early intervention. Methods Forty - two infants who were diagnosed as HIE in inpatient neonatal unit from Mar. 2003 to Mar. 2005 of the first affiliated hospital of medical college was classified as HIE group,while the 80 full - term infants who were born in the same period was assessed as contruls. To evaluate about 12 months- 7 days oht as follow- up visits.the contents of which including evaluation of infants＇ physical growth,nourishment and development state,data collection on population sociology and assessment of the infant＇s mental development index（MDI） and physical development index（PDI） by Bayley scales of infant development. MDI and PDI of 42 infants who suffered HIE and 82 normal infants were measured and comparative analysis of 2 groups in MDI, PDI rough score and standard score ,level,specific entries ,were carried out. The influnce of HIE on mental and physical development was analyzed. Results There were significant differences belween 2 groups in MDI rough score and standard score（t = 2.74,2.99 Pa 〈 0. 05 ）, but no significant differences between them in PDI（ t = 0. 12,0. 77 Pa 〉 0.05 ） ;There were significant differences between 2 groups in level of MDI standard score （x^2 = 12.04 P 〈 0.05 ）, but no significant differences between 2 groups in PDI standard score （x^2 = 0.33 P 〉 0. 05 ） ; The passover rate of HIE group in reaction ability, memory ability,settle problem ability, speech ability and recapitulation ability were all less than control group. Comparative analysis of each clauses in menial scale indicate significant differences in memory ability, settle problem ability between 2 groups （x^2 = 5.84,5.20 Pa 〈 0.05）. The incidence 42 infants who suffered HIE and 82 normal infants,of overpass of HIE group in body motor,micro muscles motor,fine motor by hand were less than control group. Comparative analysis of each clauses in motor scale indicated that significant difference only exists in fine motor by hand（x^2 = 5.40 P 〈 0. 05）. Conclusions HIE influence the progression of mental and motor. The effect of HIE upon mental development mainly manifested in memory and settle problem ability and it upon physical development mainly manifested in fine motor by hand.