脑性瘫痪高危儿肌张力异常情况的分析

Retrospective analysis of muscle tone for high-risk infants of cerebral palsy

目的:通过对6mon以内脑性瘫痪(脑瘫)高危儿初诊时肌张力异常表现和康复治疗后转归的分析,试图为早期干预的介入提供参考依据。方法:155例平均月龄为(2.46±1.46)mon的脑瘫高危儿,来自新生儿或儿科ICU病房及门诊,经临床神经系统检查和发育评定,开始实施早期康复治疗。将其高危病史、肌张力异常表现、康复治疗后的转归等情况进行分析。结果:早产、低出生体重、缺氧缺血性脑病、高胆红素血症等仍是主要的高危因素。多数患儿以肌张力升高为初诊时主要表现,小婴儿常表现为角弓反张;而肌张力低和肢体颤抖可见于2mon以内患儿,并且以后可转为张力升高。这些患儿即使在康复治疗中,也有24例曾被诊断脑瘫,最终少部分遗留轻度后遗症或临界正常。以单纯踝跖屈张力高为主要表现的患儿预后较好。结论:脑瘫高危儿出现肌张力异常表现,应及时进行针对性早期康复治疗。

Objective:Optimal management of the children with cerebral palsy(CP)requires early detection in the young infants at high risk for CP.The aim of this study is to provide some information for early detection and rehabilitation intervention by retrospective analysis muscle tone of high-risk infants at the first clinical referral and the outcome of habilitaion.Method:One hundred and fifty-five high-risk infants ranging from1day to6months(average age:2.46±1.46months)underwent this investigation.Their high risk factors,the signs of abnor-mal muscle tone and the habilitation outcome were analyzed.The muscle tone was measured by paediatric neuro-logic examination.Gesell Scale was used for evaluating infant development.Result:Premature,low birth-weight,hypoxic ischemic encephalopathies(HIE),neonatal hyperbilirubinemia were the major high-risk factors.At the first clinical referral,hypertonia was the most common type.In very young infants,hypertonic extensors of neck and trunk were usually showed.Hypotonic type and jitters could be seen in the infants younger than2months.They would probably change to hypertonic type as growing up.Even all of the infants were given early intervention,24of them were diagnosed CP during rehabilitation,and part of them eventually had sequelae or were at bor-derline.None of the infants with only hypertonic plantar flexor of ankle developed CP after early rehabilitation.Conclusion:The signs of abnormal muscle tone in high-risk infants for CP could be an indication for starting early habilitation even without definite diagnosis.