高危脑瘫婴幼儿早期康复的疗效与价值

The effect and value of early rehabilitation on infants at high risk of cerebral palsy

目的 观察高危脑瘫婴幼儿早期康复治疗的疗效 ,探讨早期康复对高危脑瘫婴幼儿预后的影响和价值。方法 经儿科医生用小儿智能发育筛查表查出的高危脑瘫婴幼儿 ,由康复医学科医生用贝利儿童发育量表对其粗大运动、精细运动、自理、认知、社交、语言等方面进行评估。将有相应功能障碍的 2 0 9名高危脑瘫婴幼儿分成 2组 :康复组 14 7名 ,对照组 62名。康复组接受神经营养药、高压氧和康复训练 ,并依发育落后的情况采取不同的康复训练方案 ;对照组接受神经营养药和高压氧治疗 ,无康复训练。用贝利婴幼儿发育量表在康复治疗前后、1.5～ 2岁时跟踪评测疗效 ,判断预后。结果 康复组治疗前、后差异非常显著 (P <0 .0 1) ,尤其是粗大运动的差异极显著 (P <0 .0 0 1)。经 3个以上疗程治疗后 ,2组在运动方面差异有非常显著性(P <0 .0 1) ,康复组疗效明显优于对照组 ,但在自理、认知、社交、语言方面 2组差异无显著性 (P >0 .0 5 )。在1.5～ 2岁跟踪评测时 2组发育迟缓人数差异有非常显著性 (P <0 .0 1) ,康复组明显低于对照组 ,但脑瘫发生率 2组差异无显著性 (P >0 .0 5 )。结论 婴幼儿时期是脑发育最迅速的时期 ,也是脑细胞的生理功能成熟和完善时期。对高危脑瘫婴幼儿进行早期康复干预 ,可促进大脑发育、发展?

Objective To observe the effect of early rehabilitation on infants at high risk of cerebral palsy, discuss its influence on the functional outcome. Methods Two hundred and nine infants at high risk of cerebral palsy were divided into two groups, 147 in rehabilitation group(group 1) and 62 in control group(group 2). Rehabilitation training was conducted solely in patients of group 1, in addition to the basic treatment (including the use of neurotrophic drugs and hyperbaric oxygenation) for both groups. Bayley Scales of Infant Development (BSID) were used to assess functions of the gross motor, fine motor, self care, cognition, social and language before / after rehabilitation intervention and as the infants were 1.5 to 2 year old. Results Significant difference was found before and after rehabilitation in cases of group 1 ( P <0.01),especially with regard to gross motor functions( P <0.001). The gross motro function was much better in group 1 than that in group 2 ( P <0.01), but there was no significant difference with regard to self care, cognition, social, language between the two groups after intervention ( P > 0.05 ). When the infants were 1.5 to 2 years old, the follow up assessment showed the incidence of motor retardation of group 1 was less than that of group 2 ( P <0.01), but there was no significant difference on the incidence of cerebral palsy between the two groups ( P >0.05). Conclusion Early rehabilitation on infants at high risk of cerebral palsy is helpful to improve and facilitate the normal motor pattern and comprehensive development of brain functions. It is important for them to have a good quality of life in the future.