全身运动质量评估对高危儿神经系统早期评估的研究

Early evaluation of nervous system in high-risk infants by whole-body exercise quality assessment

目的:探讨全身运动质量评估(General movements,GMs)、头颅核磁对高危儿神经发育不良结局早期评估的研究。方法:选取120例内蒙古自治区人民医院新生儿科住院治疗的高危儿作为研究对象,分别在矫正胎龄44周及3月龄进行全身运动质量评估;矫正胎龄足月时,出院前进行头颅核磁检查;所有患儿矫正胎龄达1岁时,依据脑瘫诊断标准、Gesell发育量表来确定发育结局;分析头颅核磁、全身运动质量评估及二者联合应用对神经系统不良发育结局的敏感性、特异性、阳性预测值及阴性预测值。结果:头颅核磁对高危儿发生运动发育迟缓、脑瘫的预测效度中,特异性分别为44.5%、99.9%,阳性预测值分别为86.7%、49.3%;阴性预测值分别为84.0%、98.5%,均较高(P<0.05),GMs的扭动阶段中,CS的敏感性分别为77.4%和99.4%,特异性分别为89.7%和77.9%,阳性预测值分别为65.3%和10.2%,较PR及CH高(P<0.05);GMs的不安运动阶段中,F-各项数值亦较高,对发育不良有良好的预测性,而头颅核磁联合GMs的应用,敏感性(91.3%)、特异性(93.7%)、阳性预测值(88.0%)均高于单独运用MRI、GMs。结论:扭动运动阶段CS、不安运动阶段F-对高危儿神经发育不良结局的预测性较好,而联合头颅核磁,对不良神经结局的预测更准确。

Objective:To explore the early assessment of neurodevelopmental outcomes in high-risk infants by general movements(GMs)and cranial magnetic resonance imaging.Methods:120 cases of high-risk infants hospitalized in Neonatology Department of People's Hospital of Inner Mongolia Autonomous Region were selected as the research objects,and the whole body exercise quality was evaluated at 44 weeks and 3 months of gestational age,and the head magnetic resonance examination was performed before discharge at full gestational age.The developmental outcomes of all infants were determined according to the diagnostic criteria of cerebral palsy and Gesell development scale when the corrected gestational age was 1 year old.The sensitivity,specificity,positive predictive value and negative predictive value of cranial magnetic resonance and whole body motion quality assessment and their combined application were analyzed on the outcomes of neurological dysplasia.Results:The predictive validity of cranial magnetic resonance for motor retardation and cerebral palsy in high-risk infants was higher(44.5%,99.9%),with higher positive predictive value(86.7%,49.3%)and negative predictive value(84%,98.5%).In the twisting stage of GMs,the sensitivity of CS(77.4%,99.4%),specificity(89.7%,77.9%),and positive predictive value(65.3%,10.2%)were higher than those of PR and CH(P<0.05).In the restless motor stage of GMs,the indicators of F-were higher and had better predictability.The sensitivity(91.3%),specificity(93.7%)and positive predictive value(88%)of the application of cranial magnetic resonance combined with GMs were higher than those of the single application of MRI and GMs.Conclusion:CS and F-in twisting and restless motor stages are better predictors of neurodevelopmental outcomes in high-risk infants,while combined with cranial magnetic resonance is more accurate in predicting adverse neurological outcomes.