多(双)胎脑瘫儿童高危因素及预后分析

Analysis on high risk factors and the results of intervention in multiple and twins cerebral palsy

目的:探讨多(双)胎脑瘫儿童高危因素与脑瘫发生率之间的关系,以及早期综合康复治疗对患儿预后的影响。方法:采用回顾性调查分析的方法,对32个家庭60例多(双)胎儿童产前母体因素、产时及新生儿危险因素进行调查分析,同时应用Gesell发育量表进行测查,并对结果进行综合分析。结果:60例多(双)胎儿童脑瘫发生率为81.6%,其中有1种、2种、3种及4种以上高危因素的脑瘫发生率分别为73.3%、80.0%、85.7%、100.0%(t=12.976,P=0.011)。脑瘫高危因素依次为低出生体重(88.3%)、早产(73.3%)、窒息(21.6%)、先兆流产(21.6%)、高胆红素血症(15.0%)、缺氧缺血性脑病(13.3%)、蛛网膜下腔出血(8.3%)、早破水(13.3%)、孕早期感染(11.6%)、低血糖(10.0%)、妊高征(10.0%)、宫内窘迫(3.3%)、器械助娩(3.3%)。所有脑瘫患儿均给予综合康复治疗,其中6月以内进行综合康复治疗的患儿总有效率为100.0%,1岁以后开始综合康复治疗的总有效率仅为45.0%(t=21.103,P=0.000)。结论:多(双)胎儿易发生早产及低出生体重等高危因素,且所合并的高危因素越多其脑瘫发生率越高(P<0.05)。早期发现和早期康复治疗可显著降低脑瘫发生率。

Objective： To investigate the relationship between the high risk factors and cerebral palsy in multiple births and twins cerebral palsy , and study the effect of early rehabilitation. Methods： We analyzed the prenatal risk factors in pregnancy, parental with ret- rospective study, and evaluated intelligence quotient with Gesell developmental schedule , in 60 cases of twins in 32 families. Results： A total of 49 cerebral palsy twins were found among the twins of 60 （81.6%） . The prevalence of twins cerebral palsy with high risk factors of one, two, three and over four were count for 73. 3%, 80. 0%, 85.7% and 100. 0% （t = 12. 976, P = 0.011 ） respectively. The main risk factors in twins cerebral palsy were light weight at birth （88. 3% ）, premature labor （73. 3% ）, stifle （21.6%）, threatened （21.6%）, hyperbilinrbinerma （ 15. 0% ）, anoxia ischemie encephalopathy （ 13. 3% ）, and et al. All cerebral palsy children were treated with synthetically rehabilitation, the rate of improvement of cerebral palsy in multiple （twins） in 6 months was 100. 0% and was 45. 0% over 12 months （t = 21. 103, P = 0. 000） . Conclusion： For multiple births and twins, the premature labor and light weight at birth are important risk factors of cerebral palsy. The more high risk factors have, the more cerebral plasy were occurred （P 〈 0. 05） . Early diagnosis and rehabilitation can decrease effectively the incidence of cerebral palsy in multiple and twins.