早产脑损伤患儿脑瘫101例的危险因素分析

Risk factors of cerebral palsy in101 preterm infants with brain injury

【目的】探讨1岁以内有神经学异常的早产脑损伤患儿发生脑瘫的危险因素,为降低其脑瘫的发生率和伤残程度、早产儿脑瘫的早期正确诊断提供临床依据。【方法】对101例年龄<1岁有神经学异常的早产脑损伤患儿进行随访观察,应用Logistic单因素法和逐步回归法分析脑瘫的危险因素。【结果】随访至2岁时101例患儿中51例(50.50%)确诊为脑瘫,出生胎龄<32周、出生体重<2 500g、头围<x--s、双眼内斜视、肌张力≥I+级、踝阵挛阳性、颅脑磁共振(MRI)显示脑室周围白质软化(periventricular leukomalacia,PVL)或基底节损伤、就诊时Gesell大运动发育商(DQ)<55分及进步速度<0.75是1岁以内有神经学异常的早产脑损伤患儿脑瘫的危险因素(P<0.05)。【结论】出生胎龄小,出生体重低、头围小、双眼内斜视,且肌张力高、踝阵挛阳性、颅脑MRI显示存在PVL或基底节损伤、就诊时大运动DQ低、进步速度慢对早产脑损伤患儿发生脑瘫有预测价值。建议临床上对早产脑损伤患儿的上述相关指标进行常规检查,并极力改善。早产儿早期肌张力增高应结合其他因素综合考虑、谨慎判断。

[Objective] To explore the risk factors of cerebral palsy in preterm infants with brain injury and provide clinic data for prevention or improvement the outcome of cerebral palsy and early diagnosis of cerebral palsy correctly in pre term infants with brain injury. [Methods] Total number of 101 preterm infants under one year of age with brain injury treated in Qingdao Rehabilitation Center for Disabled Children from January 2000 to December 2010 were followed to observe and analyse the risk factors of cerebral palsy with Logistic stepwise regression. [Results] Among the 101 infants, 51 （50.50% ） were diagnosed of cerebral palsy at the age of 2. Gestational age 〈32 weeks, birth weight %2 500 g, head circumference 〈x - s, strabismus, tone level ≥I^＋ , ankle clonus, periventrieular leukomalacia（PVL） or injury of basal ganglia regions in magnetic resonance imaging（MRI）,developmental quotient（DQ） of gross motor at base line 〈55 and progressive speed 〈0.75 were risk factors of cerebral palsy in preterm infants with brain injury（P〈0.05）. [Conclusions] The existence of small gestational age, low birth weight, small head circumference, strabismus, high tone level, ankle elonus, PVL or injury of basal ganglia regions in MRI,low DQ of gross motor and slow progressive speed can have predictive value of cerebral palsy in preterm infants with brain injury. It is recommended that preterm infants with brain injury should be examined of above-mentioned indicatrix as a routine and be improved as far as possible. An early hypertonia in preterm infants should be decided carefully combining with other conditions.