不随意运动型脑性瘫痪52例临床分析

Clinical analysis of 52 cases of involuntary movement cerebral palsy

目的:对不随意运动型脑瘫患儿的高危因素、神经影像学异常特征及其相互关系进行探讨。方法:收治不随意运动型脑瘫患儿52例,由专科医师进行全面的体格检查,采用调查问卷详细记录围产期脑损伤高危因素,以Gesell发育评估法评价神经发育水平。结果:明确的高危因素47例(90.4%),其中病理性黄疸29例(55.77%),窒息11例(21.15%),窒息+病理性黄疸7例(13.46%),其他病因5例(9.62%);MRI异常率32例(61.54%)。病理性黄疸者29例黄疸明显加重时间多在出生后5~6 d,患儿就医诊治19例,其余未诊治。结论:不随意运动型脑瘫主要高危因素是病理性黄疸与窒息。颅脑MRI表现,病理性黄疸主要损伤苍白球,早期发现病理性黄疸,积极监测,及时、有效降低血胆红素浓度是减少不随意运动型脑瘫的关键。

Objective：To explore the high risk factors,neuroimaging abnormalities and their relationship in children with involuntary movement cerebral palsy.Methods：52 children with involuntary movement cerebral were selected.The comprehensive physical examination was conducted by the specialist.The high risk factors of perinatal brain injury were recorded by the questionnaire.The Gesell development evaluation was used to evaluate the level of neurodevelopment.Results：There were 47 cases（90.4%）of high risk factors,including 11 cases of asphyxia（21.15%）,29 cases of pathological jaundice（55.77%）,7 cases of asphyxia＋pathological jaundice（13.46%）and 5 cases of other causes（9.62%）.The abnormality rate of MRI was 32 cases（61.54%）.Pathological jaundice in 29 cases of jaundice significantly aggravated more than 5-6 days after birth,19 cases of medical treatment of children,and the rest did not receive diagnosis and treatment.Conclusion：The main risk factors of cerebral palsy are pathological jaundice and asphyxia.Craniocerebral MRI manifestations,pathological jaundice mainly damages globus pallidus,early detection of pathological jaundice,active monitoring,timely and effective reduction of serum bilirubin concentration are the keys to reduce the involuntary movement of involuntary movement cerebral palsy.