《国际功能、残疾和健康分类儿童和青少年版》类目在儿童脑外伤随访中的应用

Application of international classification of functioning, disability and health for children and youth category in rehabilitation evaluation and follow-up practice of children with traumatic brain injury

目的:通过《国际功能、残疾和健康分类儿童和青少年版》(ICF-CY)在儿童脑外伤康复评定和随访的应用的研究,促进其在康复工作中的应用。方法:建立2009年1月—2012年1月在温州医学院附属第二医院康复科首次住院脑外伤患儿的档案,选取19个ICF-CY身体功能及活动和参与的二级类目、Barthel指数(BI)、格拉斯哥结局量表(GOS)对受伤年龄在2岁以上的患儿伤后1—2年的预后情况进行随访评定,并分别对ICF-CY与BI、GOS进行相关分析。结果:①47例住院患儿中,有结果的随访病例数40例(85.11%),失访人数6例,死亡人数1例,随访时间平均(16.60±4.89)个月,随访结束时平均年龄(84.63±37.52)个月。②身体功能方面,智力功能(b117)、记忆功能(b144)、步态功能(b770)恢复情况较差。活动与参与方面,精巧手的使用(d440)、四处移动(d455)、盥洗自身(d510)、学校教育(d820)/学龄前教育(d815)、参与游戏(d880)恢复情况较差。③相关性分析提示ICF-CY评分与BI得分、GOS分级呈显著负相关。结论:ICF-CY类目作为儿童脑外伤的随访内容,可以从整体水平上评估儿童脑外伤的健康状态,但要在临床上得到广泛应用仍需要很长的路要走。

Objective： To explore the use of international classification of functioning, disability and health for children and youth （ICF-CY） in rehabilitation evaluation and follow-up practice of children with traumatic brain injury （TBI）. Method： TBI children hospitalized in the rehabilitation setting were followed up when discharged. Nineteen ICF-CY body function and activity/participation categories, Barthel index （BI）, Glasgow outcome scale （GOS） were used to evaluate health status of children 1--2 years after TBI, and interrelationships among ICF-CY, BI and GOS were analyzed. Result： （1） Forty of all the 47 hospitalized children were followed up. The mean follow-up time was （16.60±4.89） months. （2） In body functions, poor recovery were frequently found in intellectual functions （b117）, memo- ry functions （b144）, gait pattern fimctions （b770）. Restrictions in their activities and participation related to fine hand use （d440）, moving around （d455）, washing oneself （d510）, school education （d820）/preschool education （d815）, engagement in play （d880）. （3） Correlation analysis showed that ICF-CY scores had significantly nega- tive correlation with BI and GOS. Conclusion： ICF-CY can comprehensively assess the health status of children with TBI, but to widely use ICF-CY in clinical practice, there is still a long way.