促肾上腺皮质激素治疗36例婴儿痉挛症的疗效分析

目的分析促肾上腺皮质激素（adrenocorticotrop hichormone,ACTH）治疗婴儿痉挛症的疗效。方法收集我院2009年1月至2012年10月36例婴儿痉挛症患儿的临床资料,分析其ACTH治疗前后发作缓解率、脑电图改变及智力发育的改善情况。结果（1）治疗结束后5d、3个月、6个月的临床完全缓解率分别为86．1％（31／36）、77．8％（28／36）、50．0％（18／36）;有效率分别为11．1％（4／36）、13．9％（5／36）、36．1％（13／36）;无效率分别为2．8％（1／36）、8．3％（3／36）、13．9％（5／36）。脑电图完全缓解率分别为75．0％（27／36）、58．3％（21／36）、44．4％（16／36）。（2）治疗后3个月、6个月分别与治疗前比较,各能区功能、智龄及发育商均有不同程度的提高（P〈0．001）;治疗后6个月与治疗后3个月比较各能区功能、智龄及发育商均有提高（P〈0．001）。尤其在大动作及适应行为、社交行为方面进步显著。结论确诊婴儿痉挛症后及时应用ACTH治疗,对控制痉挛发作、短期内提高智力发育及改善脑电图具有积极的作用。     

2007年西藏自治区碘缺乏病高危地区重点人群调查分析

Objective To propose prevention and control strategy against iodine deficiency disorders to prevent new cases of endemic cretinism from occurring. Methods In April and August 2007, all the suspected cretinism patients born after the first of January, 1997 were searched for in 16 counties from Lhasa, Shannan, Nyingchi, Qamdo and Xigaze. Meanwhile, 60 children aged 8-10 years were selected in each of the two rural villages of each county chosen. Goiter was examined using palpation and B-ultrasound, urinary iodine was determined, inteligence quotient(IQ) was tested; 30 women of childbearing age from each village chosen underwent urinary iodine test and household salt semi-quantitative detection. Results No new cases of endemic cretinism had been found; Palpation identified goiter at 4.5% (257/5680) in children, B-ultrasound revealed a rate of 4.7% (258/5433). Median of urinary iodine was 159.4 μg/L, the averaged IQ was 78.3±14.5; women of childbearing age had a median urinary iodine of 70.2 μg/L. The coverage rate of iodized salt was 52.8%. Conclusions Goiter rate in children, urinary iodine level meet the standard set for the elimination of iodine deficiency disorders; however, the low IQ children, low coverage of iodized salt and the level of urinary iodine in women of childbearing age are less than desirable. Iodine deficiency disorders prevention and control need to be strengthened.     

2007年西藏自治区碘缺乏病高危地区重点人群调查分析

Objective To propose prevention and control strategy against iodine deficiency disorders to prevent new cases of endemic cretinism from occurring. Methods In April and August 2007, all the suspected cretinism patients born after the first of January, 1997 were searched for in 16 counties from Lhasa, Shannan, Nyingchi, Qamdo and Xigaze. Meanwhile, 60 children aged 8-10 years were selected in each of the two rural villages of each county chosen. Goiter was examined using palpation and B-ultrasound, urinary iodine was determined, inteligence quotient(IQ) was tested; 30 women of childbearing age from each village chosen underwent urinary iodine test and household salt semi-quantitative detection. Results No new cases of endemic cretinism had been found; Palpation identified goiter at 4.5% (257/5680) in children, B-ultrasound revealed a rate of 4.7% (258/5433). Median of urinary iodine was 159.4 μg/L, the averaged IQ was 78.3±14.5; women of childbearing age had a median urinary iodine of 70.2 μg/L. The coverage rate of iodized salt was 52.8%. Conclusions Goiter rate in children, urinary iodine level meet the standard set for the elimination of iodine deficiency disorders; however, the low IQ children, low coverage of iodized salt and the level of urinary iodine in women of childbearing age are less than desirable. Iodine deficiency disorders prevention and control need to be strengthened.     

高压氧早期干预对缺氧缺血性脑病新生儿行为神经评分及智能发育商的影响

目的：观察早期应用高压氧干预后缺氧缺血性脑病新生儿行为神经评分及对1年后智能发育商的变化。方法：选择2002-01／2004-03收治于廉江市人民医院儿科窒息合并缺氧缺血性脑病新生儿80例。随机分为2组，常规药物组40例和高压氧早期干预组40例。常规药物组严格按照儿科治疗手册中常规3项支持疗法和3项对症处理进行早期治疗，高压氧早期干预组同时早期给予高压氧1治疗。高压氧舱为上海701所研制的SHC-1800小型氧舱，给予一级吸氧，治疗压力为0．08MPa，升压30min，减压30min，稳压40min，中间休息1次，合计100min，1次／d，10～14d为1个疗程，可治疗2～3个疗程。采用中国新生儿20项行为神经评分法，对所有患儿分别于治疗前、治疗1个疗程后各测定1次行为神经评分(满分为40分，&;lt;35分为异常)。随访1年，采用Gesell初评方法测试其动作能、应物能、应人能、言语能等4个能区的智能发育商。结果：80例患儿均完全接受了1个疗程的治疗，高压氧早期干预组中有6例继续进行2～3个疗程的治疗。两组治疗后随访1年，各有2例失访，随访率为95％。①治疗前后两组行为神经评分≥35的例数比较：高压氧早期干预组高于常规治疗组[治疗前(17，18例)，治疗后(35，27例)，X^2=4．59，P&;lt;0．05]；治疗后行为神经评分高于常规药物组(38．6&;#177;2．4，33．8&;#177;2_4，P&;lt;0．01)。②随访1年后智能发育商得分：高压氧早期干预组治疗后动作能评分较常规药物组明显提高(106．7&;#177;10．2，89．7&;#177;11.2，P&;lt;0．01)；应物能明显提高(102．3&;#177;12．06，87．7&;#177;12．2，P&;lt;0．01)；应人能明显提高(105．7&;#177;11．5，90．3&;#177;11．5，P&;lt;0．05)；言语能提高(99．7&;#177;12．0．94．4&;#177;10．2，P&;lt;0．05)。结论：高压氧早期干预治疗能提高缺氧缺血性脑病新生儿的行为神经评分及1年后智能发育商。高压氧可提高血氧分压、加大氧弥散半径、改善组织有氧代谢及组织微循环，有利于脑组织的存活和受损神经细胞的修复，可明显改善患儿的预后。     

哈尔滨市市区学龄儿童智力水平调查研究

应用《瑞文测验》对哈尔滨市市区1410名小学生进行了智力调查。结果表明,儿童平均智商水平为101.51±14.42,智商呈正态分布,证明从整体上说哈尔滨市学龄儿童的智力发育基本上是正常的。但其中太平区儿童智商较低(89.72±14.30),明显低于其它各区,并低于本智力量表的常模;智商分布向中下水平偏移;在被测试的142名儿童中,智力落后者(IQ≤69)发生率为8.5％,明显高于其它各区;其中未发现智力优秀(IQ120～129)和超优(IQ≥130)者。提示太平区儿童的智力发育受到一定损伤,该区儿童可能存在一定程度的碘缺乏。     

饮水砷暴露对儿童视觉简单反应时及联合型瑞文IQ值的影响

目的 探讨饮水砷暴露对儿童视觉简单反应时和联合型瑞文IQ值的影响.方法 于2006年4月选取内蒙古某砷暴露地Ⅸ相邻3个村的9-11岁学龄儿童为调查对象,3个村的饮水砷浓度分别为0.16mg/L(0.16mg/L砷暴露村)、0.09 mg/L(0.09 mg/L砷暴露村)和小于0.05 mg/L(对照村),检测视觉简单反应时和联合型瑞文智力测验IQ值.结果 0.16 mg/L砷暴露村儿童的视觉简单反应时中平均、最慢和最快反应时间与对照村比较均明显延长.其中0.16 mg/L砷暴露村女童的平均、最慢和最快反应时间与对照村比较,差异有统计学意义(P<0.05);0.16 mg/L砷暴露村10岁儿童的平均和最慢反应时间与对照村比较,差异有统计学意义(P<0.05).0.16 mg/L砷暴露村女童的联合型瑞文智力测验IQ值显著低于对照村(P<0.05).结论 0.16mg/L的水砷暴露可对儿童智力发育产生一定影响,女童对砷智力的损伤更为敏感.

Abstract：

Objective To explore the intellectual effects of arsenic in drinking water on children. Methods Intellectual effects were evaluated by computer-based reaction time and Combined Raven' s Test. Children aged 9 to 11 years living in three villages of Inner Mongolia were investigated in April, 2006. The arsenic concentrations in the drinking water of the three villages were 0.16 mg/L, 0.09 mg/L and less than 0.05 mg/L (control group). Results The mean, fastest and slowest visual reaction time of children exposed to the high levels of arsenic through drinking water were longer than those of children in control. The differences of mean, fastest and slowest visual reaction time between girls exposed to 0.16 mg/L arsenic and control were significant; the differences of the mean and slowest visual reaction time between 10-year old children exposed to 0.16 mg/L arsenic and control were significant. IQ of girls exposed to 0.16 mg/L arsenic was significantly lower than that in control. Conclusion Intellectual function of children can be affected by arsenic in drinking water, and the intellectual effects of arsenic on girls are more obvious.     

新生缺氧缺血性脑病智能发育相关因素探讨(附67例临床分析)

目的探讨新生儿缺氧缺血性脑病与智能发育的相关因素。方法采用Gesell智能发育量表测定智力，分析其相关因素。结果智商(DQ)≤75分占11.9%，76～85分占35.8%，86～115分占52.1%。结论重型智力障碍占多数。宫内慢性缺氧比急性缺氧引起的脑损伤更严重。缺氧缺血对神经系统的损害不亚于颅内出血。     

绘人智能测验对2515名儿童调查分析

采用日本小林重雄50分评分法,对武昌区四所不同属性的小学校6(1/2)～12岁儿童2515人,男1288人,女1227人进行绘人智能测验,然后评分查出智商(IQ),从各组IQ值的分析,发现不同年龄的儿童由于神经发育的成熟程度不同、心理发展特征不同以及环境和教育条件的影响,绘人能力存在着显著差异。结果表明,绘人智能测验法,不仅能反映儿童的特殊智能,而且对儿童的智能估价有一定的参考价值。方法简便易行,且可大力推广。     

儿童少年智商的通径分析

本文通过实例采用通径分析方法对影响儿童少年智力的多种因素进行了探讨。结果表明:学习成绩在绝大多数年龄组中对言语智商均有一定的影响,这种影响随着年龄增大逐渐减弱。性别对言语智商的影响主要反映在初中阶段。言语智商时总智商的影响比操作智商要大,提示学生的言语能力较强,而实际操作能力较差。