脑性瘫痪儿童视觉障碍的研究

A research on visual dystopia in 125 children with cerebral palsy

目的:分析脑性瘫痪儿童视觉障碍的临床特点,讨论脑性瘫痪儿童的不同类型及围产期高危因素与其合并视觉障碍的关系。方法:收集2014年7月—2014年12月确诊的125例脑性瘫痪儿童的临床资料,对其眼位、眼运动功能、眼底、屈光度等视觉功能及其可能存在的高危因素进行观察和分析。结果:1125例患儿中,存在视觉障碍的53例,视觉障碍发生率为42.40%;其中斜视43例,占受检者总数的34.40%;屈光不正39例,占31.20%;眼球震颤21例,占16.80%;眼球运动异常14例,占11.20%;眼底异常10例,占8.00%。合并的视觉障碍中以斜视与屈光不正发生率最高,分别为34.40%和31.20%。2痉挛型组视觉障碍发生率为60.94%,较其他组增高(χ2=8.56,P<0.05);痉挛型脑瘫儿童的斜视率、屈光不正的发生率分别为53.16%和42.19%,也均较其他组增高(χ2=9.32,P<0.05;χ2=8.63,P<0.05)。3早产儿组视觉障碍发生率为45.90%,高于非早产儿组(χ2=5.766,P<0.05)。4低出生体重组(BW<2.5kg组)视觉障碍的发生率为57.14%,高于其他组(χ2=18.35,P<0.05)。结论:1脑性瘫痪儿童的视觉障碍在临床常见,以斜视与屈光不正发生率最高。2痉挛型脑瘫患者视觉障碍发生率高;痉挛型脑瘫儿童的斜视率、屈光不正发生率也高。3早产、低出生体重等围生期高危因素的脑性瘫痪儿童中,合并视觉障碍的发生率高,应及早随访予以早期干预。

Objective： To study the clinical data of visual dystopia in children with cerebral palsy, and discuss the relation- ship between the visual dystopia and different types of cerebral palsy and perinatal high-risk factors. Method： The clinical data of 125 children confirmed with cerebral palsy was collected from Jul. 2014 to Dec. 2014, and the visual function was analyzed including eye position, eye movement, fi, mdus oculi, diopter and some high-risk factors of the children. Result： ①In the 125 patients, there are 53 cases with visual dystopia （42.40%）, 43 cases with strabismus （34.40%）, 39 cases with refractive error （31.20%）, 21 cases with nystagmus （16.80%）, 14 cases with eyes movement abnormality （11.20%） and 10 cases with fundus oculi abnormality （8.00%）. Among them, the high- est incidence are 34.40% and 31.20% for strabismus and refractive error respectively. ② The incidence of visu- al dystopia in group of spastic cerebral palsy （60.94%） is higher than the other groups （x^2=8.56, P 〈 0.05）. The incidence of strabismus and refractive error in group of spastic cerebral palsy is 53.16% and 42.19%, and is higher than the other groups （x^2=9.32, P〈 0.05; x^2=8.63, P〈 0.05）. ③ The incidence of visual dystopia in group of premature group is 45.90%, and is higher than non-premature group （x^2=5.766, P 〈 0.05）. ④ The inci-dence of birth weight below 2.5kg is 57.14%, and is higher than other groups significantly 0（=18.35, P〈 0.05）. Conclusion： ① The visual dystopia in children with cerebral palsy is a common complication. The incidence of strabismus and refractive error is the highest. ② The incidence rate of visual dystopia in group of spastic cerebral palsy is higher; The incidence of strabismus and refractive error in group of spastic cerebral palsy is higher, either. ③ The incidence of visual dystopia in children with cerebral palsy will be higher if there have some perinatal high-risk factors including premature or lower birth weight, and ought to follow up and give them intervention as soon as earlier.