儿童脑损伤95例临床转归分析

Analysis of clinical outcome in 95 children with different brain structures damaged

目的分析非外伤性小儿脑损伤病因及类型,揭示不同脑结构损伤患儿积极干预后的临床发育轨迹。方法收集头颅MRI提示脑结构损伤患儿95例,按损伤部位进行分类,采用综合干预康复治疗,通过病史收集、影像学、视频脑电图、丹佛发育筛查(DDST)和Gessel智商测定进行随访监测。结果新生儿期发生的脑损伤81例,占85.3%;其中PVL和枕区脑损伤共54例,占56.3%;持续积极干预智能明显进步者占83.1%(79/95);脑白质损伤癫痫发生率为27.8%(10/36),累及皮层的脑损伤癫痫发生率约66.1%(39/59),除双侧重度脑损伤外,语言发育受损程度多较轻。结论围产期是小儿脑损伤发生的主要时期。损伤类型以脑室旁白质软化、枕区灰白质损伤最常见,有足够健全的脑组织是发挥代偿的基础。小儿脑损伤代偿能力强,持续早期干预能有效降低残障出现,发育轨迹可以逆转。癫痫出现时间常伴随局部皮层功能的启动而发生,控制癫痫发作是进步的前提条件。

Objective Analysis of pediatric non traumatic brain injury causes and types, revealing different brain structures damaged in children with active intervention in clinical development track. Methods Collect 95 cases of children with the imaging of brain structure damaged. According to the structural brain damage parts to classify; U- sing comprehensive intervention treatment; Through history collection, imaging, video EEG, Denver developmental screening test （ DDST ） and Gessel IQ measured at follow-up monitoring. Results Neonatal brain damage had oc- curred in 81 （85.3%） ; PVL and occipital brain injury 54 （56.3%） ; a persistent positive intervention intelligent apparent progress accounted for 83.1% （79/95） ; Cerebral white matter injury incidence of epilepsy was 27.8% （10/36）, Involving the cortex of the brain injury epilepsy occurs at a rate of 66.1% （39/59）, In addition to bi- lateral severe brain injury and impaired to a lesser extent, language development. Conclusions The perinatal period is the main period of pediatric brain injury; Damage type with periventricular leukomalacia, occipital gray matter in- jury most frequently; have sound enough brain tissue is play a compensatory basis; Pediatric brain injury compensa- tion capability is strong, early continuous intervention can effectively reduce disability, developmental trajectories can be reversed; Epilepsy occurrence time is usually accompanied by local cortical function priming occurs; The control of epileptic seizures is a prerequisite for progress.