早产儿脑损伤早期干预模式与临床路径研究

Early multi-disciplinary intervention reduces neurological disability in premature infants

目的探讨早产儿脑损伤早期干预模式与临床路径的临床应用效果，以降低早产儿脑损伤神经伤残的发生率。方法2008年3月至2010年2月出生的早产儿117例纳入该研究，根据随机原则分为临床路径组（n=63）和对照组（n=54）。临床路径组定期发育监测、脑损伤筛查、营养神经治疗、神经发育和康复训练。对照组按照常规早期干预方案进行。结果6个月至1岁临床路径组姿势、反射、睡眠、肌张力和脑电图检查异常发生率明显低于对照组（P〈0．05）；临床路径组在纠正月龄6～24个月时智力发育指数（MDI）和运动发育指数（PDI）明显高于对照组，差异均有统计学意义（P〈0．05）。3岁时临床路径组脑性瘫痪、语言障碍、肌张力异常、听力异常发生率明显低于对照组，差异均有统计学意义（P〈0．05）。结论多学科紧密结合的早期干预模式与临床路径较对照组明显改善早产儿脑损伤的智能和运动发育水平，可进一步降低d,JL脑性瘫痪等神经伤残发生率。

Objective This study aimed to evaluate the effectiveness of multi-disciplinary treatment approaches in reducing neurological disabilities in premature infants. Methods A total of 117 infants who were born premature in our hospital between March 2008 and February 2010 but had no congenital malformations and no severe neonatal complications, were enrolled in this study. They were randomly allocated to a multi-disciplinary treatment group （n=63） and a control group （n=54）. While patients in the control group underwent an early conventional treatment, those in the multi-disciplinary treatment group were subjected to regular development monitoring, neurological examination and screening for brain injury, neuro-nutrition and neurodevelopment therapies, and rehabilitation training. Results The incidence rates of abnormalities in posture, reflex, sleep, muscle tone and EEG were significantly lower in the multi- disciplinary treatment group than in the control froup （P〈0.05） at corrected postnatal ages of 6-12 months. At corrected postnatal ages of 6, 12, 18 and 24 months, both mental development index （MDI） and psychomotor development index （PDI） scores were significantly higher in the multi-disciplinary treatment group than in the control group （P〈0.05）. At corrected postnatal age of 3 years, incidence rates of cerebral palsy, language barrier, abnormal muscle tone and hearing impairment were significantly lower in the multi-disciplinary treatment group than in the control group （P〈0.05）. Conclusions Early multi-disciplinary intervention approaches may significantly improve mental and motor developments and reduce the incidence of cerebral palsy-associated neurological disabilities in premature infants.