先天性心脏病儿童神经心理发育状况及影响因素研究

Current status of neuropsychological development and its influencing factors in children with congenital heart disease

目的分析先天性心脏病(CHD)儿童的神经心理发育状况及影响因素,为促进CHD儿童神经心理发育提供科学依据。方法采用1:1病例对照研究方法,按相同月龄、性别、地区进行配对。选取2019年1月—2021年12月在昆明医科大学附属延安医院预防保健科进行儿童保健的符合条件348对12~36月龄的儿童为研究对象。采用面对面方式进行统一问卷调查,收集社会人口学特征及相关信息,应用“0~6岁儿童发育筛查测验”(DST)对儿童神经心理发育状况进行筛查。比较病例组和对照组儿童神经心理发育的状况,分析影响CHD儿童发育的因素。结果CHD组发育商(DQ)、智力指数(MI)均低于对照组(P<0.001),房间隔缺损组神经心理发育优于其他类型CHD儿童。多因素有序多分类Logistic回归分析显示:男性(OR=4.505,95%CI:1.717~17.241)、早产(OR=9.091,95%CI:1.538~47.121)、独生子女(OR=3.802,95%CI:1.051~13.889)是CHD儿童DQ落后的危险因素,母亲工作类型为弹性时间工作(OR=0.118,95%CI:0.029~0.487)、定期儿童保健(OR=0.233,95%CI:0.098~0.553)可降低CHD儿童DQ异常的风险;早产(OR=3.906,95%CI:1.346~11.364)是CHD儿童MI落后的危险因素,母亲工作类型为弹性时间工作(OR=0.219,95%CI:0.052~0.923)、定期儿童保健(OR=0.224,95%CI:0.089~0.560)可降低MI异常的风险。结论CHD儿童神经心理发育水平仍不理想,需进一步研究和干预并制定适合我国CHD儿童的评估和治疗标准。

Objective To investigate the current situation and related influencing factors of neuropsychological development in children with congenital heart disease(CHD),so as to provide scientific basis for enhancing the neuropsychological development.Methods A 1:1 case-control study was designed matched by age,gender and residential type.From January 2019 to December 2021,a total of 348 pairs of infants aged 12 to 36 months were enrolled in this study from the Department of Preventive Healthcare,Yan'an Hospital Affiliated to Kunming Medical University.Cases and controls were interviewed face to face with a uniformed questionnaire to collect their socio-demographic data.Developmental Screening Test(DST)for children under six was used to conduct neuropsychological test among these children.The neuropsychological development status of children in the two groups was compared.Factors related to the neuropsychological development of children with CHD were then analyzed.Results The scores of development quotient(DQ)and mental index(MI)among children with CHD were lower than those in the control group(P<0.001).The neuropsychological development of children with atrial septal defect was better than that of children with other types of CHD.Multivariate Logistic regression analysis showed that male children(OR=4.505,95%CI:1.171-17.241),premature(OR=9.091,95%CI:1.538-47.121)and only children(OR=3.802,95%CI:1.051-13.889)were risk factors for delayed DQ of CHD children,while flexible working arrangement of mothers(OR=0.118,95%CI:0.029-0.487),regular healthcare(OR=0.233,95%CI:0.098-0.553)were associated with lower risk of DQ retardation.Premature(OR=3.906,95%CI:1.346-11.364)were significantly associated with MI delays,while flexible working arrangement of mothers(OR=0.219,95%CI:0.052-0.923),regular healthcare(OR=0.224,95%CI:0.089-0.560)were related to lower risk of MI retardation.Conclusions The neuropsychological development of CHD children is still unsatisfactory.Further studies are warranted in order to make neurodevelopmental evaluation strategies for children with CHD.