颈总动脉周围交感神经网剥脱切除术联合Bobath法康复训练治疗3～6岁脑瘫患儿的临床效果观察

Clinical Observation of Carotid Artery Peripheral Sympathetic Nerve Net Stripping Resection Combined with Bobath Rehabilitation Training in 3-6 Year-old Children with Cerebral Palsy

[目的]探讨颈总动脉周围交感神经网剥脱切除手术联合Bobath康复法治疗3-6岁脑瘫患儿中临床效果。[方法]选择2010年6月至2015年2月本院收治的82例3-6岁脑瘫患儿为研究对象，根据患儿家属意愿等将患儿分为观察组和对照组，每组各41例，观察组组给予两组患儿颈总动脉周围交感神经网剥脱切除手术及Bobath康复法治疗，对照组给予Bobath康复法治疗。一个疗程后观察两组患儿的临床疗效，经颅多普勒检测大脑中动脉血流指标，其中使用粗大运动功能（GMFM）评分对两组患儿的运动功能进行评价。[结果]1个疗程后观察组患儿的有效率为95．12％（39／41），显著高于对照组的43．90％（18／41），差异具有统计学意义（χ^2=5．086，P=0．026〈0．05）。治疗前两组患儿的GMFM评分中各项评分指标比较，均无统计学差异（均P〉0．05）；治疗后两组患儿的GMFM评分中各项评分均高于治疗前，且观察组患儿GMFM评分中各项评分均高于对照组，差异均具有统计学意义（均P〈0．05）。经颅多普勒检测显示治疗前两组患儿的大脑中动脉血流情况比较，差异无统计学意义（均P〉0．05）；治疗后观察组患儿大脑中动脉均值流速、峰值流速、舒张末流速均显著高于治疗前，且高于对照组，差异均具有统计学意义（均P〈0．05）。[结论]颈总动脉周围交感神经网剥脱切除手术联合Bobath法康复训练能有效增加脑瘫患儿脑部血液的供应量，能明显改善脑瘫患儿的运动功能，其临床疗效显著，值得在临床工作中推广应用。

[ObjectivelTo observe the clinical effect of carotid artery peripheral sympathetic nerve net stripping resection combined with Robath rehabilitation training in cerebral palsy children of 3- 6 years old. [Methods]Eighty-two cases of children with cerebral palsy were collected in our hospital from June 2010 to February 2015 as the research subjects. All children were divided into an experi- mental group and a control group randomly （ n = 41 cases each）. Children in the experimental group were given carotid artery peripheral sympathetic nerve net stripping resection surgery and Bobath rehabilitation training. Children in the control group were given Bobath rehabilitation training alone. After a course of treatment, the therapeutic effect, Doppler detection of middle cerebral artery flow, and GMFM scores of the two groups were compared. [Results]The effective rate of the experimental group was 95.12%（39/41）, which was significantly higher than that of the control group （43.9% ,18/41）. The difference was statistically significant （χ^2=5.0860.026, P〈0.026）. There were no significant differences in the scores of GMFM between the two groups before treatment （ P 〉0.05）. After a course of treatment, the GMFM scores in the two groups were higher than those before treatment （ P〈0.05）, and the GMFM scores of the experimental group scores were higher than those of the control group （ P〈0.05）. Transcranial Doppler analysis showed that there was no significant difference in the middle cerebral artery blood flow between the two groups before treatment （ P 〉0.05）. After treatment, the mean arterial velocity, peak velocity, diastolic velocity of the middle cerebral artery in the experimental group were sig- nificantly higher than those in the control group （ P〈0.05）. The experimental group＇s curative effect and the improvement of motor function were significantly higher than those of the control group. The middle artery blood flow of the experimental group also had ob vious improvement after treatment. [Conclusion]The carotid artery peripheral sympathetic nerve net stripping resection combined with Bobath rehabilitation training can obviously improve the patients＇ motor function as well as significantly enhance middle cerebral artery blood flow and increase clinical efficacy.