综合性康复训练对缺氧缺血性脑病早产儿患者智能及神经系统发育的影响

Effect of comprehensive rehabilitation training on intelligence and nervous system development in premature infants with hypoxic ischemic encephalopathy

目的探讨综合性康复训练对缺氧缺血性脑病早产儿患者智能及神经系统发育的影响。方法选取2013年1月~2017年2月该院儿科治疗HIE早产儿共150例,根据家长是否积极参与康复锻炼分为康复组114例与对照组36例。两组早产儿早期均予吸氧、控制惊厥、降颅压、控制血压、血糖和营养神经等基础治疗。对照组早产儿予以育儿指导、病情监测、门诊复查及父母心理干预等常规干预。康复组早产儿在对照组治疗基础上给予综合性康复训练。两组均干预24个月。观察两组早产儿干预前后智能发育指标及神经元特异性烯醇化酶(NSE)变化,并比较两组神经系统后遗症。结果干预12个月和24个月后,康复组早产儿适应能力、语言能力、精细运动能力、大运动能力和社交能力等智能发育评分均明显高于对照组(P<0.05)。干预24个月后,两组早产儿血清NSE水平均较干预前显著下降(P<0.05或P<0.01),且康复组早产儿下降幅度更显著(P<0.05);且康复组神经系统后遗症发生率为5.26%(6/114),明显低于对照组的19.44%(7/36)(χ2=4.06,P<0.05)。结论综合性康复训练用于HIE早产儿可减少中枢神经系统损伤,促进智能及神经系统发育,开发患儿潜在潜能,降低神经系统后遗症发生率,改善预后。

Objective To investigate the effects of comprehensive rehabilitation training on the intelligence and nervous system development of premature infants with hypoxic ischemic encephalopathy.Methods A total of 150 children with HIE premature infants in pediatric department of our hospital from January 2013 to February 2017 were enrolled.According to whether the parents actively participated in rehabilitation exercises,the children were divided into 114 patients in the rehabilitation group and 36 patients in the control group.Both groups of preterm infants were given basic treatment including oxygen therapy,control of convulsions,reduction of intracranial pressure,control of blood pressure and blood sugar,and nutrition for nerves.Premature infants in the control group were given routine interventions such as parenting guidance,condition monitoring,outpatient review,and parental psychological intervention.Premature infants in the rehabilitation group were given comprehensive rehabilitation training based on the treatment of the control group.Both groups were treated for 24 months.The changes of intelligent development index and neuron-specific enolase(NSE)before and after intervention in the premature infants of the two groups were observed,and the sequelae of the nervous system were compared.Results After 12 months and 24 months of intervention,the intelligent development scores of adaptablity,language ability,fine motor ability,large exercise capacity and social ability in the rehabilitation group were significantly higher than those in the control group(P<0.05).After 24 months of intervention,the serum NSE levels of the preterm infants in the two groups were significantly lower than those before the intervention(P<0.05 or P<0.01),and the decrease rate of preterm infants in the rehabilitation group was more significant(P<0.05).And the neurological sequelae occurrence rate in the rehabilitation group was 5.26%(6/114),which was significantly lower than that of the control group 19.44%(7/36)(χ2=4.06,P<0.05).Conclusion Comprehensive rehabilitation training for HIE premature infants can reduce central nervous system damage,promote intelligence and nervous system development,develop potential of children,reduce the incidence of neurological sequelae,and improve prognosis.