早期康复干预治疗早产儿脑损伤疗效观察

Effect of early rehabilitation on brain injury in preterm infants

目的探讨早期康复干预治疗早产儿脑损伤的临床效果。方法选择2014年2月至2016年6月郑州市第三人民医院收治的脑损伤早产儿136例,根据治疗方法将患儿分为早期康复组和对照组,每组68例。对照组患儿给予吸氧、保温、维持血压和血糖正常、纠正酸碱平衡失调和电解质紊乱、营养支持等常规治疗,早期康复组患儿在常规治疗基础上给予早期康复干预。记录2组患儿出生时、康复干预12个月后的头围、身长和体质量;分别于康复干预第3、6、9、12个月应用婴幼儿智能发育量表测定患儿智力发育指数(MDI)和运动发育指数(PDI),康复干预12个月后观察2组患儿后遗症和体格发育落后情况。结果出生时2组患儿身长、体质量及头围比较差异均无统计学意义(t=0. 291、0. 325、0. 364,P> 0. 05);康复干预12个月后早期康复组患儿身长、体质量及头围显著大于对照组(t=2. 563、4. 396、2. 213,P <0. 05)。康复干预第3个月时2组患儿MDI及PDI比较差异无统计学意义(t=0. 424、0. 738,P> 0. 05);康复干预第6、9、12个月时早期康复组患儿MDI和PDI显著大于对照组(tMDI=2. 382、2. 543、3. 024,tPDI=2. 441、3. 219、3. 547,P <0. 05)。干预12个月后,对照组患儿出现脑性瘫痪15例(22. 06%),精神发育异常6例(8. 82%),癫痫3例(4. 41%),听力障碍2例(2. 94%);早期康复组患儿出现脑性瘫痪6例(10. 29%),精神发育异常3例(4. 41%),癫痫2例(2. 94%),听力障碍1例(1. 47%)。对照组患儿身长、体质量、头围发育落后分别有20例(29. 41%)、26例(38. 24%)和25例(36. 76%),早期康复组患儿身长、体质量、头围发育落后分别有5例(7. 35%)、4例(5. 88%)和6例(8. 82%)。早期康复组患儿脑性瘫痪及身长、体质量、头围发育落后发生率显著低于对照组(χ~2=4. 562、11. 027、20. 700、15. 083,P <0. 05),2组患儿精神发育异常、癫痫及听力障碍发生率比较差异无统计学意义(χ~2=0. 876、0. 193、0. 326,P> 0. 05)。结论早期康复干预能有效促进脑损伤早产儿的智力、运动和体格发育,降低脑性瘫痪发生率。

Objective To investigate the clinical effect of early rehabilitation on brain injury in premature infants.Methods A total of 136 premature infants with brain injury in the Third People′s Hospital of Zhengzhou City from February 2014 to June 2016 were selected as the study subjects.The children were divided into early rehabilitation group and control group according to the treatment method,68 cases in each group.The children in the control group were treated with routine treatment such as oxygen inhalation,heat preservation,maintenance of normal blood pressure and blood sugar,correction of acid-base imbalance and electrolyte disturbance and nutritional support.The children in the early rehabilitation group were treated with early rehabilitation on the basis of conventional treatment.The head circumference,body length and body mass of the children were recorded at birth and 12 months after rehabilitation intervention.The mental development index(MDI)and psychomotor development index(PDI)were measured by the children intelligence development scale at the 3 rd,6 th,9 th and 12 th month of rehabilitation intervention.The sequelae and growth retardation of the children in the two groups were observed after 12 months of rehabilitation intervention.Results There was no significant difference in body length,body mass and head circumference of the children between the two groups at birth(t=0.291,0.325,0.364;P>0.05).The length,body mass and head circumference of the children in the early rehabilitation group were significantly larger than those in the control group after 12 months of rehabilitation intervention(t=2.563,4.396,2.213;P<0.05).There was no significant difference in MDI and PDI of the children between the two groups at the 3 rd month of rehabilitation intervention(t=0.424,0.738;P>0.05).The MDI and PDI of the children in the early rehabilitation group were significantly higher than those in the control group at the 6 th,9 th and 12 th month of rehabilitation intervention(t MDI=2.382,2.543,3.024;t PDI=2.441,3.219,3.547;P<0.05).After 12 months of rehabilitation intervention,there were 15(22.06%)cases of cerebral palsy,6(8.82%)cases of mental dysplasia,3(4.41%)cases of epilepsy and 2(2.94%)cases of hearing impairment in the control group;there were 6(10.29%)cases of cerebral palsy,3(4.41%)cases of mental dysplasia,2(2.94%)cases of epilepsy and 1(1.47%)case of hearing impairment in the early rehabilitation group;there were 20(29.41%),26(38.24%)and 25(36.76%)children with growth retardation in the body length,body mass and head circumference respectively in the control group;there were 5(7.35%),4(5.88%)and 6(8.82%)children with growth retardation in the body length,body mass and head circumference respectively in the early rehabilitation group.The incidences of cerebral palsy and the growth retardation of body length,body mass and head circumference in the early rehabilitation group were significantly lower than those in the control group(χ^2=4.562,11.027,20.700,15.083;P<0.05).There was no significant difference in the incidences of mental development disorders,epilepsy and hearing impairment of the children between the two groups(χ^2=0.876,0.193,0.326;P>0.05).Conclusion Early rehabilitation intervention can effectively promote the intellectual,motor and physical development of premature infants with brain injury,and reduce the incidence of cerebral palsy.