高危儿综合管理的模式探讨与评价

目的:探讨高危儿综合管理的模式并评估其可行性及有效性。方法:建立高危儿随访中心,设立随访流程、转诊模式、干预模式。结果:综合管理后3年较前3年、管理后第2、3年较管理后第1年高危儿建档数及随访率均明显提高,差异有统计学意义(P<0.01);1岁时早产儿随访组中大运动、精细动作、认知能力、语言、社交能力及总发育商(developmentalquotient,DQ)均高于失访组(P<0.05),而与正常对照组相比差异无统计学意义(P>0.05);大运动发育迟缓或姿势异常早期干预的康复率达100%,随访至2岁的儿童无脑瘫发生。结论:建立高危儿监测网络,依托三级妇幼保健网络实行医疗机构多学科及家庭相结合的早期干预模式,早期发现、早期干预、建立长期随访机制是提高高危儿管理率及减少伤残儿童发生的有效、可行的管理模式。

Investigation and evaluation of comprehensive management mode of high-risk infants

Objective:To explore the comprehensive management mode of high-risk infants,and evaluate the feasibility and effectiveness.Methods:The follow-up center of high-risk infants was established,the process of follow-up,transfer mode,and intervention mode were designed.Results:The registration numbers and follow-up rates of high-risk infants at the latter three years and on the first year after comprehensive management were statistically significantly higher than those at the former three years and on the second year and the third year(P<0.01);the scores of large motor,fine movement,cognitive ability,language,sociability,and total developmental quotient(DG) of premature infants at one year in follow-up group were statistically significantly higher than those in lost-to-follow-up group(P<0.05),but there was no significant difference compared with normal control group(P>0.05);the rehabilitation rate of large motor developmental delay or abnormal posture after early intervention was 100%,all the infants were followed up for two years,no cerebral palsy occurred.Conclusion:An effective and feasible management mode to improve management rate of high-risk infants and reduce disabled children includes establishing monitoring network,conducting early intervention mode of multiple departments of medical institutes combined with family based on three-level maternal and child health care network,early detection,early intervention,and constructing long-term follow-up system.