痉挛型脑性瘫痪患儿静脉输液方法的研究

目的探讨对痉挛型脑性瘫痪患儿于姿势控制后行静脉输液穿刺的效果。方法将接受静脉输液治疗的痉挛型脑瘫患儿158例随机分为常规组77例，按护理基本技术操作规程实施常规输液；干预组81例，在姿势控制后进行输液。比较2组输液时间和一次性穿刺成功率。结果常规组一次穿刺成功率64．3％，干预组一次穿刺成功率88．3％，2组比较差异有统计学意义（P〈0．05）。常规组平均耗时（5．77±3．60）min，干预组平均耗时（4．92±3．21）min，2组比较差异无统计学意义（P〉0．05）。结论对痉挛型脑性瘫痪患儿进行合理的姿势控制后行静脉输液．可有效提高穿刺成功率。     

痉挛型脑性瘫痪患儿静脉输液方法的研究

目的 探讨对痉挛型脑性瘫痪患儿于姿势控制后行静脉输液穿刺的效果.方法 将接受静脉输液治疗的痉挛型脑瘫患儿158例随机分为常规组77例,按护理基本技术操作规程实施常规输液;干预组81例,在姿势控制后进行输液.比较2组输液时间和一次性穿刺成功率.结果 常规组一次穿刺成功率64.3%,干预组一次穿刺成功率88.3%,2组比较差异有统计学意义(P＜0.05).常规组平均耗时(5.77±3.60)min,干预组平均耗时(4.92±3.21)min,2组比较差异无统计学意义(P＞0.05).结论 对痉挛型脑性瘫痪患儿进行合理的姿势控制后行静脉输液,可有效提高穿刺成功率.     

功能性脑疾病患者静脉输液难点分析及对策

目的:探讨功能性脑疾病患者静脉输液难点及相应对策。方法:对65例功能性脑疾病患者的输液治疗难点进行分析,并采取相应对策。结果:静脉输液存在很多困难,存在制动难、选择血管难、固定难、配合难、输液维持难等问题。结论:经过临床探索,采取有效制动、掌握最佳穿刺时机、合理正确的选择血管及输液用具、妥善固定以及安排有经验的操作护士等措施,可提高穿刺成功率,降低复穿率。     

132例脑性瘫痪患儿脑电图分析

脑性瘫痪是指出生前到出生后1个月内由于各种原因所致的非进行性脑损伤．主要表现中枢性运动障碍及姿势异常。常伴癫痫、智力地下、行为及感知觉障碍。为探讨脑电图(EEG)在脑性瘫痪中的应用价值．现将我院132例脑性瘫痪患儿脑地形图结果报告如下。     

脑性瘫痪患儿的心理特征及治疗对策

目的:探讨脑性瘫痪患儿的心理特征及相应的护理对策。方法:对40例脑性瘫痪患儿进行2个月-1年的综合康复治疗,并采用针对性的心理护理对策。结果:治疗后,显效10例(25%),有效15例(37.5%),进步13例(32.5%),无效2例(5%),总有效率为95%。结论:掌握脑性瘫痪患儿的心理特征,制定相应的护理对策,可促进患儿身心全面康复,提高患儿的生活质量。     

脑性瘫痪患儿脑电图和脑CT分析

脑性瘫痪(脑瘫)表现为中枢性运动障碍和姿势异常。对脑瘫神经病理检查指出，脑瘫颅脑组织1／3可见肉眼异常，表现为脑组织的瘢痕、软化、硬化、萎缩，脑体积变小，脑回变窄，脑沟变宽，囊变，脑积水等。2／3病例可见显微镜下变化。CT检查可反映小儿大脑组织结构损伤的有无程度和部位。脑电图检查可了解脑瘫儿是否合并症状性癫痫和智力低下等。     

脑性瘫痪患儿368例脑电图分析

脑性瘫痪是出生前至生后1个月内各种原因所致的非进行性脑损伤,主要表现为中枢性运动障碍及姿势异常,部分患儿伴有智力低下、癫痫、行为异常或感知觉障碍。为了解脑性瘫痪患儿脑电图表现,我们将368例脑性瘫痪患儿的脑电图与临床资料报告分析如下。     

脑性瘫痪患儿未坚持治疗的原因分析

为明确脑性瘫痪患儿未坚持治疗的原因,84例患儿分为2组,一组为未坚持治疗组,另一组为坚持治疗组,两组进行多因素对比分析。未坚持治疗组在性别、年龄、家庭经济情况、居住地方面与坚持治疗组比较,差异无显著性意义(P<0.05),在运动障碍程度、认知能力低下程度、家长受教育程度、家人支持程度方面差异有显著性意义(P<0.05)。脑性瘫痪患儿的治疗应多方面考虑。     

Identifying assessment measures and interventions reported for Thai children with cerebral palsy using the ICF-CY framework

Background: Cerebral palsy (CP) is the most common disability in childhood. The International Classification of Functioning, Disability and Health (ICF) provides a standard framework for classifying performance in people with disability, including children with CP. Linking measures actually reported with the ICF classification promotes best practice, especially pertinent in developing countries such as Thailand. This study aimed to explore the charted demographic data, assessment and intervention measures reported for children with CP in Central region of Thailand using the ICF for children and youths (ICF-CY) framework to clarify the scope of actual management practice in this population. Methods: Charts of children admitted to four public hospitals and two schools in 2007–2009 were age stratified, and approximately 48% audited (n?=?269). Results: Contextual information was clearly reported, and measures could be classified across all components of the ICF, being mainly classified in Body Structures and Functions and to a lesser degree, in Activities and Participation. Our ability to compare across cultures was affected by poor recording practices limiting the amount and quality of data available. Conclusions: Classifying measures of children with CP in Thailand in terms of the ICF-CY framework demonstrates their holistic management as well as where gaps need to be addressed, and thus contributes to best practice.

Implications for Rehabilitation

• Assessments and interventions reported for children with CP in Central region, Thailand cover all components of the ICF-CY, and describe the individual roles of the Inter-professional team members.

• Local health practitioners should consistently conform with internationally practice by using Standardized tools assessing all components of the ICF

• Consistent and uniform charting practices should be used to provide accurate interpretation of actual practice, as well as a clear pathway from assessment to intervention.

     

CT在脑性瘫痪早期诊断中的价值

目的探讨CT在小儿脑性瘫痪(脑瘫)早期诊断中的价值。方法对124例小儿脑瘫的头颅CT进行回顾性研究与分析。结果124例中96例头颅CT检查阳性,CT异常率77.42％,其中脑萎缩是最常见的表现(54.84％)。临床类型中痉挛型最多见(71.77％)。不同年龄组中,年龄越小,CT异常率越高。结论虽然CT不能作为诊断脑瘫的主要依据,但有助于早期发现病变,有助于寻找病因及定位,还可以为判断本病的预后提供依据,在脑瘫的早期诊断中具有重要价值。     

小儿脑瘫的家庭康复

目的探讨小儿脑瘫的家庭康复。方法对 15例脑瘫患儿进行系统的家庭康复治疗 1年。结果基本正常 3例 ,有效10例 ,无效 2例。结论小儿脑瘫的家庭康复治疗是一种有效、经济、简单易行的康复治疗方法     

脑瘫患儿气质特征研究

目的探讨脑瘫患儿气质特征。方法采用修订的Carey儿童气质问卷中文电子软件版 ,对 3 64例 4个月— 7岁脑瘫患儿进行气质分析 ,比较不同临床类型、独走和未独走患儿气质特征。结果脑瘫患儿有明显消极气质 ,表现为活动性低、注意力欠集中、坚持性差、情绪本质消极等 ;痉挛型双瘫和徐动型患儿趋避性有明显区别 ;不同智力水平脑瘫患儿未见气质差异 ;不能独走患儿的消极气质明显。结论脑瘫患儿有明显的消极气质。     

辅助器具在小儿脑性瘫痪康复中的选用探讨

本文针对小儿脑性瘫痪(脑瘫)康复中辅助器具的作用和选用进行探讨,并介绍了60多种供个人使用和训练用的相关辅助器具。在小儿脑瘫的康复过程中需要应用辅助器具来改善脑瘫患儿的功能障碍、帮助建立正常的运动模式、防止畸形进一步加重和提高他们的生活自理能力。为此着重提出了小儿脑瘫肢体残疾辅助器具选用时要考虑的3个因素即按照儿童运动发育规律、按照脑瘫儿功能障碍的身体部位、按照脑瘫儿的日常生活能力来选用。此外,有部分辅助器具将伴随脑瘫儿一生,成为他们回归社会的无障碍通道。     

痉挛型双瘫的临床特征

目的：探讨痉挛型双瘫的临床特征,为脑功能的全面康复提供基础资料。方法：对５０ 例痉挛型双瘫患儿的临床资料进行回顾性分析。结果：５０ 例中３５ 例为早产儿（７０％）,高危因素依次为早产、低体重、缺氧、硬肿症、颅内出血;１５ 例为足月儿（３０％）,高危因素主要为窒息、缺氧缺血性脑病。５０ 例患儿运动神经功能异常,全部表现为骨盆带及下肢痉挛及由此所致的姿势异常,双上肢受累较轻。平均精细运动年龄１８．５ 个月,粗大运动年龄８．７５ 个月（Ｐ＜ ０．０１）。半数患儿同时合并斜视、语言发育迟缓和／ 或运动性构音障碍。结论：痉挛型双瘫的病因,运动神经系统表现具有特征性,对其正确的认识评价有助于康复计划的制订。     

小儿脑性瘫痪弱视调查

目的：对脑瘫患儿弱视的发生及相关因素进行探讨。方法：对１４５ 例脑瘫患儿进行视力、眼位、眼底、视觉诱发电位、视网膜电流图进行检查。结果：斜视２６ 例（１８％）,为共同性斜视,内斜１４ 例,外斜１２ 例。弱视检出率为５０％ （７３／１４５）,双眼弱视５４ 例,单眼弱视１９ 例,轻度弱视７３ 眼（５７％）,中度弱视５５ 眼（４３％）,重度弱视９眼（７％） 。１２７ 只弱视眼中屈光不正１２３ 眼（９７％）。ＶＥＰ异常７２ 眼,Ｐ１００ 潜伏期延长。Ｆ－ ＦＲＧ异常３５ 眼,ｂ 波幅降低。结论：及早验光、矫正屈光不正是小儿脑瘫弱视防治的关健     

静脉输液技术分层管理的临床实践

目的:探讨静脉输液技术分层管理的实用性。方法:依据静脉输液技术分层级标准和技术准入管理体系对临床护士实施分层管理,观察实施前后的静脉穿刺结果、并发症发生率、穿刺工具选择合理性及患者满意度。结果:实施前后的静脉穿刺结果、并发症发生率、穿刺工具选择合理性差异有统计学意义,患者满意度提高。结论:静脉穿刺技术分层管理是技术准入制度在临床的具体实践,也是我国静脉输液专业化队伍建设的有效尝试。     

Responsiveness of evaluative measures for children with cerebral palsy: The Gross Motor Function Measure and the Pediatric Evaluation of Disability Inventory

Purpose.?The aim of this study is to describe responsiveness of the Gross Motor Function Measure (GMFM) and the Pediatric Evaluation of Disability Inventory (PEDI) in a group of children with cerebral palsy (CP).

Method.?The subjects were 55 children with cerebral palsy aged 2 to 7 years (mean 4.6 years). We described the responsiveness of the GMFM and PEDI for all children (n = 55), for children younger than 4 years of age (n = 22) and those older or equal to 4 years (n = 33).

Two frames of references for determining responsiveness were used: change over time and external criterion. Responsiveness was calculated with help of the Effect Size (ES), Standardised Response Mean (SRM) and Spearman rank order correlations of change on both the PEDI and GMFM, with change in motor functioning according to the parents as external criterion.

Results.?The PEDI has ES and SRM values higher than 0.8. The GMFM has ES and SRM values higher than 0.5. For all dimensions of the PEDI and for almost all dimensions of the GMFM, the ESs and SRMs of the younger group are higher than those of the older group. The ES and the SRM of the GMFM increase with the complexity of the task. When looking at the correlations of the PEDI and GMFM change scores with the opinion of parents, the results are less unequivocal.

Conclusions.?Both the GMFM and the PEDI are responsive for change in motor ability over time in children with CP, the most in children younger than 4 years of age.