南通市0～1岁脑性瘫痪高危儿早期分级综合干预治疗效果研究

Effect of early classification and comprehensive intervention on children under 1-year-old with cerebral palsy risks in Nantong

目的探讨早期分级、评估及综合干预治疗对0~1岁脑性瘫痪高危儿的影响,为降低当地脑瘫儿的发生率、减轻残疾儿童的功能障碍程度提供科学有效的依据。方法利用全市的脑瘫高危儿转诊系统,对南通市2011年1月1日-12月31日出生的新生儿进行筛查,筛选出的高危儿进行神经系统检查,同时采用PDMS-2量表进行早期分级。其中,神经系统检查异常且总运动商（total motor quotient,TMQ）〈80的高危儿,征求家长意愿,分为常规育儿组和早期干预组,分别进行早期教育、综合干预治疗,并于3、6、9、12月龄定期评估。结果本次研究的高危儿最终确诊脑瘫人数为7人,脑瘫的发生率为3.4‰,远低于国内报道的全国脑瘫高危儿脑瘫发病率的7.8‰和南通地区报道的发病率8.1‰,其中,早期干预组脑瘫的发生率明显低于常规育儿组（P〈0.05）;影响脑瘫高危儿早期综合干预效果的因素很多,以低出生体重和高胆红素血症最为显著（P〈0.05）。结论早期分级与综合干预能降低脑瘫高危儿脑瘫的发生率。

Objective To explore the effects of early classification,assessment and comprehensively treatment of cere- bral palsy （CP） high-risk infants,and to provide scientific and effective evidences for reducing the local incidence of CP and the dysfunction degree of disabled children. Methods The referral system of Nantong was used to screen CP high-risk in- fants from newborns in Nantong between January ist, 2011 and December 31st, 2011. Neuro exams and early classification were conducted among them according to PDMS-2 scale. CP high-risk infants with neurological abnormal and the total motor quotient （ TMQ ）〈80 were divided into two groups after approval from parents：conventional group and early intervention group. Early education and comprehensive intervention were given to each child and regular evaluations were made after 3,6, 9 months and 12 months. Results Among all of the high-risk infants,7 cases were eventually confirmed CP,the incidence was 3.4‰,which was far less than national CP incidence of 7.8‰ and local incidence of 8.1‰ in Nantong area. The inci- dence of CP in early intervention group was significantly lower than that in conventional group （P〈0.05）. Many factors in- fluenced the effects of early comprehensive intervention for CP high-risk infants. Among them,low birth weight and hyper- bilirubinemia were the most important （P〈0.05）. Conclusions Early classification and comprehensive intervention of children with CP risks can help reduce the incidence of cerebral palsy.