56例脑瘫患儿睡眠相关问题分析

目的 探讨脑瘫患儿睡眠相关问题.方法 采用儿童睡眠习惯问卷(The Children′s Sleep Habits Questionaire,CSHQ)调查了2.5～9岁脑瘫患儿56名和幼儿园就读的健康儿童64名.结果 脑瘫患儿平均睡眠时间为(9.80±1.13)h,健康儿童平均睡眠时间为(10.12±1.09)h(P＜0.05);睡眠习惯问卷中,脑瘫患儿总平均分为(51.43±7.57)分,健康儿童总平均分为(46.67±7.02)分(P<0.05);8项睡眠习惯评分比较,脑瘫组与健康组在睡眠潜伏期、睡眠持续情况、睡眠焦虑、夜醒情况、白天嗜睡5个方面差异有统计学意义(P＜0.05).结论 (1)与同龄健康儿童相比,脑瘫患儿存在多种睡眠问题;(2)年龄越小的脑瘫患儿,睡眠问题与同龄健康儿童相比差异越大.     

4～9岁癫痫患儿睡眠相关问题研究

目的了解4～9岁癫痫患儿睡眠问题的发生率及其影响因素。方法选取2009年12月—2011年6月就诊于湖南省儿童医院的53例癫痫患儿为研究对象,采用儿童睡眠习惯问卷及自编的一般情况调查问卷对患儿家长进行调查。结果癫痫患儿平均睡眠时间为(8.88±0.77)h,健康儿童平均睡眠时间为(9.84±0.66)h,差异有统计学意义(P<0.01);睡眠习惯问卷中,癫痫患儿总平均分为(47.58±3.18)分,健康儿童总平均分为(42.83±2.22)分,差异有统计学意义(P<0.01);8项睡眠习惯评分比较,癫痫患儿与健康儿童在睡觉抵触、睡眠潜伏期、睡眠持续情况、睡眠焦虑、夜醒情况、白天嗜睡6个方面差异有统计学意义(P<0.05)。在癫痫组中,总平均分以睡眠中发作为主、发作形式为全面性发作及智能发育落后的患儿更高,差异有统计学意义(P<0.05)。结论睡眠问题是癫痫患儿最常见的健康问题,应加强睡眠健康教育,对癫痫患儿睡眠情况进行早期监测与指导,提高癫痫患儿的生活质量。     

学龄期癫痫儿童睡眠问题及其影响因素分析

目的 探讨原发性或可能症状性学龄期癫痫儿童的睡眠问题及其相关影响因素.方法 采用中文版儿童睡眠习惯问卷(CSHQ)对54例学龄期(7~12周岁)原发性和可能症状性癫痫儿童及54例性别、年龄严格匹配的学龄期健康儿童进行调查.结果 癫痫组在CSHQ总分及8个层面中的6个(睡眠抵触、入睡潜伏期、睡眠焦虑、夜醒、异态睡眠、白天嗜睡)得分与对照组相比差异有统计学意义(P<0.05).在癫痫组中,不同年龄段CSHQ总分及睡眠抵触、入睡潜伏期、睡眠持续时间、睡眠焦虑4个层面相比差异有统计学意义(P<0.05);发作控制组和未控制组在CSHQ总分及除入睡潜伏期层面的其他层面差异均有统计学意义(P<0.05);不同发作频率CSHQ总分及除睡眠呼吸障碍层面的其他层面差异均有统计学意义(P<0.05);不同发作类型CSHQ总分和睡眠抵触、睡眠持续时间、睡眠焦虑、白天嗜睡4个层面相比差异有统计学意义(P<0.05);不同发作时间段CSHQ总分及睡眠抵触、入睡潜伏期、睡眠持续时间、睡眠焦虑、夜醒层面5个层面相比差异有统计学意义(P<0.05);单药治疗组和多药治疗组CSHQ总分和入睡潜伏期、夜醒、异态睡眠、白天嗜睡4个层面差异有统计学意义(P<0.05).多元线性回归分析显示,性别、年龄、控制与否、发作频率、发作类型、发作时间段、抗癫痫药物种类是CSHQ总分或其某些层面分数的主要影响因素.结论 癫痫患儿较健康儿童更易出现睡眠问题,其睡眠问题的发生可能与多种因素相关.     

穴位神经治疗儿童孤独症睡眠障碍的临床疗效观察

目的:观察穴位神经疗法对儿童孤独症睡眠障碍的临床疗效。方法:选取2011-2013年宁夏医科大学总医院心身医学科进行鉴定的60例儿童自闭症患者,按照随机数字表法将其分为试验组和对照组各30例,试验组采用HANS穴位神经治疗仪配合综合性干预措施进行治疗,对照组采用综合性干预措施进行治疗。两组试验前后均使用《儿童睡眠习惯问卷(CSHQ)中文版》和《3~7岁儿童气质量表》进行评价,观察比较两组患儿的治疗效果及治疗前后的CSHQ评分。结果:试验组总有效率86.7%(26/30)明显高于对照组的46.7%(14/30),差异有统计学意义(字2=10.800,P=0.001)。试验组治疗后的就寝习惯、入睡潜伏期、睡眠焦虑、夜醒、异态睡眠、睡眠呼吸障碍等方面的评分及CSHQ总分均明显优于治疗前,差异均有统计学意义(P0.05或P0.01);对照组治疗后仅在睡眠持续时间和白天嗜睡层面的评分优于治疗前,差异均有统计学意义(P0.05)。两组各个气质类型的治疗有效率比较差异均无统计学意义(P0.05)。结论:神经穴位治疗对儿童孤独症睡眠障碍有明显的缓解作用,不仅能促进患儿本身病情的改善,也能极大地提高患儿及家长的生活质量,值得在临床上推广。     

褪黑素治疗40例癫痫患儿睡眠障碍的临床观察

目的探讨褪黑素治疗癫痫患儿睡眠障碍的疗效。方法应用褪黑素治疗2.5~7岁有睡眠障碍的癫痫患儿40例,以治疗2个月前后的儿童睡眠习惯问卷(the children′s sleep habits questionaire,CSHQ)评分变化进行对照的开放性研究。结果 40例癫痫患儿使用褪黑素治疗2个月前后8项睡眠习惯评分比较,睡眠潜伏期、睡眠持续情况、睡眠焦虑、夜醒情况等项中差异有统计学意义(P<0.05)。结论褪黑素治疗癫痫患儿的睡眠障碍疗效良好。     

简化版口面肌功能训练在儿童腺扁桃体切除术后应用效果分析

目的:探讨简化版口面肌功能训练在儿童腺扁桃体切除术后应用效果.方法:随机选取2020年行腺扁桃体切除术的26例患儿为观察组,2019年行腺扁桃体术的30例患儿为对照组.对照组采取常规护理干预,观察组采取简化版口面肌功能训练干预,观察简化版口面肌功能训练依从性,并比较2组儿童干预前后各时间点阻塞性睡眠障碍问卷(OSA-18)总分及各维度得分情况.结果:观察组依从性较差者有8例(26.9％),依从性较好者有18例(73.1％).2组儿童OSA-18总分及各维度得分在出院后3个月和6个月均高于手术前(P<0.05～P<0.01),且观察组在总分、睡眠障碍、身体症状和白天功能维度得分均呈现递减趋势(P<0.01);干预前2组OSA-18总分和各维度得分比较差异均无统计学意义(P>0.05),出院后3个月,睡眠障碍、身体症状和对照顾者影响维度,观察组得分均低于对照组(P<0.05～P<0.01),而情绪不佳和白天功能维度,2组差异无统计学意义(P>0.05);出院后6个月,除白天功能维度2组比较差异无统计学意义(P>0.05),其余维度观察组得分均低于对照组(P<0.05～P<0.01).结论:简化版口面肌功能训练能够改善儿童腺扁桃体术切除术后睡眠障碍、身体症状和情绪问题,值得在临床护理干预中推广应用.     

褪黑素治疗脑损伤儿童睡眠障碍的疗效观察

目的探讨外源性褪黑素应用于脑损伤患儿睡眠障碍的效果。方法所有病例于每晚临睡前30 min服用3 mg褪黑素,若1周无效,增加至每晚6 mg,若2周无效,增加至每晚9 mg。采用儿童睡眠习惯问卷(the children′s sleep habits question-aire,CSHQ)观察治疗前后各睡眠指标的变化。结果治疗2~3周后睡眠抵触较前改善,睡眠潜伏期较前缩短,夜醒次数较前减少,CSHQ总分较前降低,治疗前后比较,差异有统计学意义(P<0.05)。结论褪黑素治疗脑损伤儿童睡眠障碍具有改善部分睡眠指标的疗效。     

早期睡眠干预策略对婴儿体格生长与睡眠觉醒模式的影响

目的 探讨干预方法对婴儿体格生长与睡眠觉醒模式的影响及对婴儿睡眠问题的作用.方法 选取2014年5-8月自愿在该院健康管理的600例1月龄健康婴儿,分为干预组和对照组,监护人填写睡眠问卷,均接受每月普通儿保常规指导随访至6月龄.干预组由睡眠专科医生发放婴儿睡眠健康教育宣传页进行睡眠认知教育和睡眠问题咨询,对睡眠问题婴儿按睡眠健康处方进行综合干预.结果 比较两组婴儿体格生长指标、睡眠觉醒模式指标和睡眠问题发生率:(1)干预组婴儿身高较对照组有明显差异(P＜0.05).(2)干预组夜醒次数、夜醒时间、白天睡眠次数、白天睡眠总时间明显低于对照组(P＜0.05),干预组夜间总睡眠时间较对照组增加(P＜0.05),入睡潜伏期、入睡时间、白天小睡时间与对照组差异无统计学意义(P＞0.05).(3)干预组6月龄时睡眠问题在夜醒过度方面明显低于对照组(P＜0.05),在入睡超时、觉醒/就寝节律紊乱方面无明显差异.结论 认知行为干预和健康教育的早期干预策略能够对0～6个月婴儿体格生长及睡眠觉醒模式产生有利影响,能减少婴儿睡眠问题的发生.     

慢性肾脏病患儿生活质量与家庭复原力的相关性研究

目的 调查慢性肾脏病(CKD)患儿的生活质量和家庭复原力现状,并分析二者的相关性.方法 2020年3-6月采用便利抽样选取重庆市某三级甲等儿童医院300例CKD患儿家庭,采用家庭复原力评定量表(FRAS)及儿童生活质量测定量表(PedsQLTM 4.0)进行调查.结果 CKD患儿家庭复原力总分为(190.54±33.15)分;不同年龄段患儿的生活质量总分分别为:2～4岁(70.88±11.62)分、5～7岁(71.93±12.57)分、8～12岁(77.71±11.15)分、13～18岁(76.12±12.40)分.CKD患儿生活质量总分及各维度得分与家庭复原力总分及各维度得分均呈正相关(P<0.05).结论 CKD患儿的生活质量相对较低,家庭复原力处于中等水平,患儿的生活质量与家庭复原力密切相关.     

利培酮和孤独症儿童睡眠障碍的关系

目的：研究利培酮在治疗孤独症儿童的睡眠障碍中的作用。方法：对伴有睡眠障碍的23例孤独症儿童,经8周的利培酮治疗,在治疗前后用“儿童睡眠习惯问卷中文版”对患儿进行评分,以评估其是否有差异。结果：在就寝习惯、入睡潜伏期、睡眠持续时间、睡眠焦虑及夜醒等5个层面上,治疗后的评分均明显低于治疗前,有显著性差异（P〈0．05）,而异态睡眠、睡眠呼吸障碍和白天嗜睡这3个层面在治疗前后的评分则无显著性差异（P〉0．05）。结论：利培酮可以显著地改善孤独症儿童的睡眠障碍。     

运用结构化教育对自闭症儿童康复训练的效果分析

目的:分析采用结构化教育对自闭症儿童进行康复训练的疗效。方法:对接受结构化教育康复训练的22名自闭症儿童,采用自闭症儿童发展及行为量表,由专业人员进行康复训练前后测评。结果:康复训练后自闭症儿童功能发展的七个范围均有显著提高(P<0.001)。结论:运用结构化教育法对患有自闭症的儿童进行康复训练是治疗自闭症的有效方法之一,在提高他们各项功能的同时,病态行为将得以减轻或消除,为他们今后融入社会奠定较好的基础。     

孤独症患儿血清催产素水平与社交能力关系的研究

目的 探讨孤独症儿童与健康儿童血清催产素水平差异及其与孤独症儿童社交能力的关系.方法 选取3~5岁孤独症患儿25例与健康儿童20例分别接受血清催产素水平测量,采用社交反应量表评定孤独症儿童社交能力.结果 独立样本t检验显示孤独症患儿血清催产素水平低于健康儿童,比较差异有统计学意义(P<0.05).孤独症儿童患者血清催产素水平与其社交能力呈负相关(r=-0.735,P<0.01).多元线性回归模型分析显示孤独症儿童患者中,催产素水平是影响社交能力的因素(F=11.931,P<0.01).结论 与健康儿童相比,孤独症儿童患者存在血清催产素水平异常,血清催产素水平可能是影响其社交能力的因素.     

孤独症儿童及其Ⅰ级亲属血浆五羟色胺水平的对照研究

目的 通过测定儿童孤独症核心家系五羟色胺(5-HT)水平,探讨孤独症先证者及其Ⅰ级亲属的5-HT水平的家族聚集性特征.方法 采用高效液相色谱仪测定儿童孤独症组(38例)及其亲生父母组(61例)的5-HT水平,并与年龄和性别相匹配的正常儿童对照组(35例)及正常成人对照组(60例)的5-HT水平相比较.结果 ①儿童孤独症组的血浆5-HT水平为(212.51±127.98)μmol/L,显著高于正常儿童对照组(t=3.842,P=0.000);②孤独症父母组的血浆5-HT水平为(88.15±48.15)μmol/L,显著高于正常成人对照组(t=3.409,P=0.001).③儿童孤独症的病情严重程度与血浆5一HT水平两者之间无显著相关(r=0.142,P=0.041).④孤独症儿童组的血浆5-HT水平与孤独症儿童的父亲和母亲的血浆5-HT水平两者之间均存在显著相关(r=-0.498,P=0.000;r=-0.602,P=0.000).结论 儿童孤独症血浆5-HT增高并与遗传因素相关,可作为中间表型为孤独症遗传易感因子的研究提供线索.     

Autism and mental retardation of young children in China

To understand the prevalence and rehabilitation status of autism and mental retardation in China. Methods Screening test and clinical assessment were conducted for the diagnosis of autism and mental retardation. The assessment included investigation of the histories of medical conditions and development of these two disorders, utilization and needs for the rehabilitation service, and related intellectual and behavioral appraisal. Results Among the 7345 children investigated, the prevalence of autism disorder was 1.10 cases per 1000 children aged 2-6 years （95% CI=0.34 to 2.54）, and the prevalence of mental retardation was 10.76 cases per 1000 children （95% CI=8.40 to 13.12）. All the children suffering from autistic disorder were intellectually disabled, whereas 31.0% of the non-autism mental retardates had other disabilities. The medical conditions prior to birth and perinatal period were important potential factors for autism. Half of the autistic children and 84% of the children with non-autism mental retardation had never received any rehabilitative service. Conclusions The prevalence of autistic disorder in children aged 2-6 years in Tianjin is rather high. It is urgent to improve the status of the autistic and intelligently disabled young children in China. In order to upgrade the level of early diagnostic and improve the intervention to autism and mental retardation, public awareness and training courses should be heightened.     

Incidence of autism spectrum disorders in children in two Australian states

AIM: To ascertain the incidence of autism spectrum disorders in Australian children. SETTING: New South Wales (NSW) and Western Australia (WA), July 1999 to December 2000. DESIGN: Data were obtained for WA from a prospective register and for NSW by active surveillance. MAIN OUTCOME MEASURES: Newly recognised cases of autism spectrum disorders (defined as autistic disorder, Asperger disorder and pervasive developmental disorder not otherwise specified [PDD-NOS]) in children aged 0-14 years; incidence was estimated in 5-year age bands (0-4 years, 5-9 years, 10-14 years). RESULTS: In WA, 252 children aged 0-14 years were identified with autism spectrum disorder (169 with autistic disorder and 83 with Asperger disorder or PDD-NOS). Comparable figures in NSW were 532, 400 and 132, respectively. Most children were recognised with autistic disorder before school age (median age, 4 years in WA and 3 years in NSW). Incidence of autistic disorder in the 0-4-years age group was 5.5 per 10,000 in WA (95% CI, 4.5-6.7) and 4.3 per 10,000 in NSW (95% CI, 3.8-4.8). Incidence was lower in older age groups. The ratio of all autism spectrum disorders to autistic disorder alone was 1.5:1 in WA and 1.3:1 in NSW, and rose with age (1.8:1 and 2.9:1 in 10-14-year-olds in WA and NSW, respectively). CONCLUSIONS: These are the first reported incidence rates for autism for a large Australian population and are similar to rates reported from the United Kingdom. Ongoing information gathering in WA and repeat active surveillance in NSW will help to monitor any future changes.     

Prevalence and Early Signs of Autism Spectrum Disorder （ASD） among 18-36 Month Old Children in Tianjin of China

Objective The aim of this study is to estimate the prevalence of autism spectrum disorder （ASD） among 18-36 month old children in the Tianjin Municipality of China, and to identify early signs of autistic children and the predictability of each individual symptom.
Methods A total of 8 000 children were screened to do a questionnaire based on CHAT modified to include more early signs of autism at the age of 28-36 months. Then the at-risk children were reexamined 1.5 years later and ASD children were identified based on DSM-IV. Early signs of autism were analyzed retrospectively by using discriminant function analysis performed among ASD children, children not followed up and children followed up but failing to meet ASD criteria.
Results Three hundred and sixty seven children were screened as being at-risk to ASD, and 22 of them were identified as having ASD in the subsequent diagnosis. The prevalence of ASD was 27.5 per 10 000 in Tianjin of China with a male to female ratio of 4：1. Items addressing social interactions and communications had higher predictability than other items to distinguish autistic children from non-autistic ones. Pretend play, functional play, showing and reading parents＇ facial expressions distinguished autistic children from those not followed up, nevertheless those followed up but failing to meet ASD criteria were not included.
Conclusion The prevalence of ASD found in our study was lower than that reported in some studies by western researchers. Autism has its specific symptoms, such as deficits in social awareness, social relatedness, and social referencing.     

自闭症的中医治疗研究进展

综述近10年来中医治疗自闭症的研究概况。自闭症的中药治疗多基于肾亏失养、脾虚痰阻、肝失疏泄、脾肾不合、心脾两虚等开展辨证论治,以口服用药为主;其非药物中医疗法有针刺、推拿、耳穴贴压等。近年来,中医基于“治未病”“整体观”“辨证论治”等原则,采用中药、针刺、推拿、耳穴贴压及相关联合疗法等治疗自闭症,在改善患儿症状等方面,取得了一定疗效。但目前中医疗法治疗自闭症研究仍存在明显不足,今后有待针对自闭症患儿病理生理特点,改进各中医疗法;尽快开展多中心、大样本的中医规范化疗法治疗自闭症的临床研究,追踪远期疗效,以提高中医治疗自闭症的有效性的证据级别。     

低功能孤独症患儿听觉统合训练疗效研究及心理护理

目的探讨听觉统合训练(auditory integration training,AIT)及心理护理对儿童孤独症低功能患者的疗效及其持续性。方法将48例低功能孤独症患儿随机分为实验组和对照组,实验组接受AIT治疗及心理护理,对照组在实验期间不作治疗,实验结束后给予同等治疗。疗效评估主要采用孤独症儿童行为检查量表(Autism Behavior Checklist,ABC),比较治疗前,治疗结束当天,治疗后1个月、2个月、3个月ABC分值的变化。结果 5例患儿失访。实验组经过AIT治疗后,与对照组比较,ABC分值明显下降(P<0.05);治疗结束当天,治疗后1个月、2个月、3个月ABC分值持续下降。结论 AIT对低功能儿童孤独症的临床症状有疗效,且在3个月内持续作用。