小儿脑瘫危险因素与合并症相关分析

目的:分析小儿脑瘫危险因素与合并症以及与脑瘫分型构成比。方法:回顾性调查2001年1月至2007年12月期间的602例脑瘫患儿临床资料,了解脑瘫高危因素与合并症的关系以及与脑瘫分型构成比与合并症的发生率,用卡方检验统计分析。结果表明:602例脑瘫患儿中有522例存在高危因素占86.71%(522/602),主要危险因素依次为窒息、早产低出生体重、其他因素、黄疸、宫内感染、多胎/双胎、颅内出血和脐带异常;有551例患儿伴有合并症占91.53%(551/602)、合并智力低下434例(72.09%)、语言障碍262例(43.52%)、癫痫134例(22.26%)、听力障碍133例(22.09%)、视神经萎缩155例(25.75%)、摄食困难352例(58.47%)、流涎457例(75.91%)。不同脑瘫分型之间有显著性差异(P<0.05),其中以痉挛型、手足徐动型与混合型脑瘫并发症发生率最高(P<0.01);结论:脑瘫危险因素与合并症存在高度相关性,脑瘫是一种脑损伤引起的多重复合征,严重影响脑瘫患儿的心身发育,在治疗过程中注重整体康复,以利提高生命质量。     

肌力训练对痉挛型脑瘫患儿ADL的影响

目的：主要研究肌力训练对痉挛型脑瘫患儿日常生活活动能力（activities of daily living,ADL）的影响。方法：把40例痉挛型脑瘫患儿随机分成研究组和对照组各20例,对照组采用痉挛肌群的手法牵伸及常规的神经发育技术治疗,研究组在此基础上进行肌力训练,在治疗前和治疗6个月后分别对两组脑瘫患儿ADL进行评估。结果：研究组在治疗前的ADL得分为：（67.8&#177;8.11）分,治疗后为：（82.8&#177;9.19）分;对照组在治疗前的ADL得分为：（68.3&#177;8.32）分,治疗后为：（73.4&#177;8.06）分;治疗后研究组ADL得分明高于对照组（P〈0.05）,在统计学上有显著差异。结论：肌力训练可以提高痉挛型脑瘫患儿的日常生活活动能力（activities of daily living,ADL）。     

肌力训练对痉挛型脑瘫患儿ADL的影响

目的:主要研究肌力训练对痉挛型脑瘫患儿日常牛活活动能力(activities of daily living,ADL)的影响.方法:把40例痉挛型脑瘫患儿随机分成研究组和对照组各20例,对照组采用痉挛肌群的手法牵伸及常规的神经发育技术治疗,研究组在此基础上进行肌力训练,在治疗前和治疗6个月后分别对两组脑瘫患儿ADL进行评估.结果:研究组在治疗前的ADL得分为:(67.8±8.11)分,治疗后为:(82.8 ±9.19)分;对照组在治疗前的ADL得分为:(68.3±8.32)分,治疗后为:(73.4±8.06)分;治疗后研究组ADL得分明高于对照组(P＜0.05),在统计学上有显著差异.结论:肌力训练可以提高痉挛型脑瘫患儿的日常生活活动能力(activities of daily living,ADL).     

Clinical and MRI correlates of cerebral palsy: the European Cerebral Palsy Study

Context  Magnetic resonance imaging (MRI) findings have been reported for specific clinical cerebral palsy (CP) subgroups or lesion types but not in a large population of children with all CP subtypes. Further information about the causes of CP could help identify preventive strategies. Objective  To investigate the correlates of CP in a population sample and compare clinical findings with information available from MRI brain studies. Design and Setting  Cross-sectional, population-based investigative study conducted in 8 European study centers (North West London and North East London, England; Edinburgh, Scotland; Lisbon, Portugal; Dublin, Ireland; Stockholm, Sweden; Tübingen, Germany; and Helsinki, Finland). Participants  Five hundred eighty-five children with CP were identified who had been born between 1996 and 1999; 431 children were clinically assessed and 351 had a brain MRI scan. Main Outcome Measures  Standardized clinical examination results, parental questionnaire responses, MRI results, and obstetric, genetic, and metabolic data from medical records. Results  Important findings include the high rate of infections reported by mothers during pregnancy (n = 158 [39.5%]). In addition, 235 children (54%) were born at term while 47 children (10.9%) were very preterm (<28 weeks). A high rate of twins was found, with 51 children (12%) known to be from a multiple pregnancy. Clinically, 26.2% of children had hemiplegia, 34.4% had diplegia, 18.6% had quadriplegia, 14.4% had dyskinesia, 3.9% had ataxia, and 2.6% had other types of CP. Brain MRI scans showed that white-matter damage of immaturity, including periventricular leukomalacia (PVL), was the most common finding (42.5%), followed by basal ganglia lesions (12.8%), cortical/subcortical lesions (9.4%), malformations (9.1%), focal infarcts (7.4%), and miscellaneous lesions (7.1%). Only 11.7% of these children had normal MRI findings. There were good correlations between the MRI and clinical findings. Conclusions  These MRI findings suggest that obstetric mishaps might have occurred in a small proportion of children with CP. A systematic approach to identifying and treating maternal infections needs to be developed. Multiple pregnancies should be monitored closely, and the causes of infant stroke need to be investigated further so preventive strategies can be formulated. All children with CP should have an MRI scan to provide information on the timing and extent of the lesion.      

推拿对脑瘫小儿短潜伏时体感诱发电位的影响

观察了３０例脑瘫小儿推拿治疗前后的胫神经刺激性短潜伏时体感诱发电位（ＳＳＥＰ）。该电位一般由Ｐ１８、Ｎ２３、Ｐ３１、Ｎ４３Ｐ５４和Ｎ６８６个波组成。治疗前，患儿ＳＳＥＰ表现为波低平、延迟，左右侧波不对称和无反应等，异常率达９３％。经４个多月的推拿治疗，除１例继续变差、３例无变化外，其余患儿的ＳＳＥＰ电压升高，其中患侧波较治疗前增大４４．３４％～１３６．７％（Ｐ＜０．０５）；潜伏时缩短，患侧波Ｐ１８、Ｎ２３和Ｐ３１较治疗前有统计学意义（Ｐ＜０．０５）。治愈率为２５％，总有效率为８５．７１％。结果表明，推拿能改善息几大脑皮层及体感通路的功能。     

脑瘫与围产期嗜神经病毒感染——一项新研究引发了对感染作用的进一步探讨

脑瘫是引起长期严重残疾的最常见原因之一，其含义是指“继发于发育早期脑异常病变的非进展性运动障碍”。不可逆的脑部病变通常与以下几种因素的综合作用有关：遗传、胚胎感染、早产、分娩异常。产后感染的作用在婴幼儿期严重的脑膜脑炎或脑炎过程中是明确的。但是在先天性脑瘫和新生儿脑瘫中感染的作用更为复杂，有待进一步研究。本期（第89页）的一项病例对照研究，检测了新生儿筛查血样中嗜神经病毒核酸的感染率，若结果确凿，将有助于提高对该病的认识。     

中医“五联”疗法改善痉挛型脑瘫肌张力临床研究

目的观察中医＂五联＂疗法改善痉挛型脑性瘫痪肌张力的临床疗效。方法将144例确诊为痉挛型脑性瘫痪的患儿随机分为治疗组（中医＂五联＂加运动疗法72例）、对照组（运动疗法加经络导推治疗及痉挛肌治疗各36例）,治疗前和治疗1个月、2个月、3个月时分别由康复评定师用改良的Ashworh分级法评定标准评定肌张力,将MAS评级转化为评分,1级为1分,1＋级为1.5分,2级为2分3,级为3分4,级为4分,治疗前进行1次评估作为基数,治疗后每满1个月对肌张力情况进行评价,治疗3个月,观察治疗组的疗效,治疗前后肌张力评分相差≥1分为有效。结果治疗组与对照组组间及各组自身前后肌张力评分对比,从第2个月开始有显著差异,3个月时差异更突出;治疗组3个月总有效率为91.18.%,对照组3个月总有效率为48.52%,两组比较差异有统计学意义（P〈0.05）。结论中医＂五联＂疗法在降低痉挛型脑性瘫痪的肌张力方面疗效明显。