超早期干预对脑瘫高风险儿神经和运动发育的影响

doi:10.3969/j.issn.2095-9400.2021.04.008

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摘要目的：探讨超早期干预对脑瘫高风险儿神经和运动发育的影响。方法：将2017年1月至2018年1月在浙江省中医院下沙院区出生并诊断为脑瘫高风险新生儿53例纳入观察组，再将同期至浙江康复医院就诊的脑瘫高风险儿（3～5月龄）46例纳入对照组，另将同期在浙江省中医院下沙院区出生的健康新生儿50例纳入健康组。观察组患儿在诊断后（出生后7 d内）进行干预，重点采用神经发育学疗法（NDT）；对照组患儿在诊断后（3～5月龄）接受干预的措施和流程与观察组相同。比较3组间各月龄期发育商（DQ）、GESELL发育量表（GDS）评分的变化，以及随访至24月龄时，观察组和对照组达到正常化、进展为脑瘫和全面性发育落后的比例。结果：在基线、3月龄时，观察组各能区DQ、总DQ、GDS（适应性、大运动、精细动作、语言、个人社交）评分均显著低于健康组（P＜0.05）；在6月龄、12月龄、18月龄和24月龄时，3组间各功能区DQ、总DQ、GDS（适应性、大运动、精细动作、语言、个人社交）评分差异均有统计学意义（P＜0.05）；观察组和对照组各功能区DQ、总DQ、GDS（适应性、大运动、精细动作、语言、个人社交）评分均显著低于健康组（P＜0.05）；而观察组显著高于对照组（P＜0.05）。观察组正常化率高于对照组，脑瘫和全面性发育落后发生率低于对照组（P＜0.05）。结论：超早期干预可改善脑瘫高风险儿的生活质量，提高脑瘫高风险儿正常化率，降低脑瘫发生率。

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	王臣
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	潘少华

关键词 ：脑性瘫痪, 新生儿, 超早期干预, 神经发育, 运动发育

Abstract：Objective: To explore the effect of ultra-early intervention on the improvement of nerve and motor development in infants at high risk of cerebral palsy. Methods: From January 2017 to January 2018, 53 newborns, who were born in Xiasha District-Zhejiang Hospital of TCM and diagnosed as infants at high risk of cerebral palsy, were enrolled in the observation group, 46 infants at high risk of cerebral palsy (3-5 months old), who came to Zhejiang Rehabilitation Hospital in the same period, were enrolled in the control group, and 50 healthy newborns, who were born in Xiasha District-Zhejiang Hospital of TCM in the same period, were enrolled in the healthy group. The children in the observation group were intervened after diagnosis (within 7 days after birth), and the Neurodevelopmental therapy (NDT) was mainly used. The intervention measures and procedures used in the control group were the same as those of the observation group. The scores of development quotient (DQ), Gesell development scale (adaptability/the gross motor/fine motor/language/personal social contact) were observed among the three groups at each month, and were compared at 24 months of age between the observation group and the control group in the proportion of patients who reached normalization, progressed to cerebral palsy and lagged in overall development. Results: The scores of DQ in each functional area, total DQ, Gesell development scale (adaptability/the gross motor/fine motor/language/personal social contact) of the observation group were significantly lower than those of the healthy group (P<0.05) at baseline and 3 months old, and the scores of DQ in each functional area, total DQ, Gesell development scale (adaptability/the gross motor/fine motor/language/personal social contact) of the three groups were statistically significant (P<0.05) at 6, 12, 18 and 24 months old. The scores in the observation group were significantly higher than those in the control group (P<0.05). The rate of normalization in observation group was higher than in control group, and the incidence of cerebral palsy and general underdevelopment was lower than that of the control group, but there was no significant difference between the two groups (P>0.05). Conclusion: For infants at high risk of cerebral palsy, ultra-early diagnosis and intervention can improve the normalization rate of high-risk infants with cerebral palsy and reduce the incidence of cerebral palsy which is of significant clinical benefit.

Key words： cerebral palsy newborn ultra-early intervention neurodevelopment motor development

收稿日期: 2020-08-26

通讯作者: 潘少华，副主任医师，Email：962889775@qq.com。 E-mail: 962889775@qq.com

作者简介: 王臣，主管治疗师，Email：wccn1003@163.com。

链接本文:

https://xb.wmu.edu.cn/CN/10.3969/j.issn.2095-9400.2021.04.008 或 https://xb.wmu.edu.cn/CN/Y2021/V51/I4/298

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