早产儿生后早期头颅磁共振成像结果预测远期脑性瘫痪价值的meta分析

目的 通过meta分析定量评价早产儿生后早期头颅磁共振成像结果预测远期发生脑性瘫痪的临床价值. 方法 计算机检索PubMed、Embase、Cochrane、中国生物医学文献数据库、中国期刊全文数据库、维普数据库和万方数据库中关于早产儿头颅磁共振成像结果预测脑性瘫痪的相关文献.纳入标准:(1)研究目的为评价早产儿生后早期头颅磁共振成像结果预测远期神经预后的价值;(2)研究类型为前瞻性的队列研究与随机对照试验以及回顾性的病例分析与病例对照研究;(3)头颅磁共振成像的检查时间窗为小于纠正年龄3个月;(4)脑性瘫痪诊断金标准为随访结果,且诊断标准明确.采用Stata11.0统计软件进行meta分析,计算敏感性、特异性、阳性和阴性似然比.结果 共纳入7篇英文文献,772例早产儿,发生脑性瘫痪92例.早产儿生后早期头颅磁共振成像结果预测远期发生脑性瘫痪的合并敏感性为0.93(95％CI:0.65～0.99),特异性为0.89(95％CI:0.81～0.93),阳性似然比为8.19(95％CI:4.48～14.94),阴性似然比为0.08(95％CI:0.01～0.52),总受试者工作特性曲线下面积为0.95(95％CI:0.92～0.96).合并值存在明显异质性,差异有统计学意义(P＜0.05).排除1篇回顾性研究与1篇低发病率文献后异质性显著降低(P＞0.10),预测精确性相应有所降低,合并敏感性为0.81(95％CI:0.58～0.93),特异性为0.82 (95％ CI:0.76～0.87). 结论 早产儿生后早期头颅磁共振成像结果预测远期脑性瘫痪的发生可能具有较高的精确性,尤其是对阴性结果,排除价值较高.而对于具有高危因素的早产儿,头颅磁共振成像的阳性结果,预测效率可能更高.     

脑性瘫痪儿童118例脑电图特点分析

目的总结脑性瘫痪（简称脑瘫）患儿脑电图异常分类,探讨脑电图与脑瘫类型之间的关系。方法采用国际10／20系统电极放置法,对118例脑瘫患儿清醒、睡眠等状态下进行视频脑电图检查,并对结果进行分析。结果118例脑瘫患儿的脑电图异常率为73．73％（87／118）;脑瘫分型中不随意运动型脑瘫的脑电图异常率较低38．46％（5／13）。结论脑瘫患儿脑电图异常率与其脑损伤部位有关,应定期进行脑电图检查。     

50例脑性瘫痪患儿高危因素分析

目的分析小儿脑性瘫痪(简称脑瘫)相关高危因素,为预防该病提供参考。方法 2013年10月至2015年3月辽宁中医药大学附属医院儿科康复中心收治50例脑瘫患儿,为观察组。同期选择100例非脑瘫患儿和健康儿童进行1∶2匹配,为对照组。通过查阅住院病历及询问儿童父母完成问卷调查。调查项目包括妊娠高血压、多胎、早期破水、早产、低体质量、新生儿窒息、颅内出血。数据采用Logistic回归分析。结果单因素分析显示,早产、低体质量、多胎、病理性黄疸、新生儿窒息、羊水早破、缺氧缺血性脑病、感染8项指标是发生小儿脑瘫的危险因素,差异有统计学意义(P0.05);多因素分析显示,早产、低体质量、病理性黄疸、新生儿窒息、多胎为小儿脑瘫发病的主要危险因素。结论小儿脑瘫病因复杂,做好围产期和分娩期的保健工作是重中之重。     

引导式教育治疗小儿脑性瘫痪30例疗效观察

目的观察引导式教育疗法对脑瘫患儿的治疗作用。方法将60例脑瘫患儿随机分为观察组和对照组各30例。观察组采用引导式教育疗法加常规康复治疗,对照组采用常规康复治疗方法,治疗2个疗程。两组患儿治疗6个月后采用PDMS-2评估及ADL评分进行比较。结果两组治疗后Peabody运动发育量表第2版评分及生活自理能力评分结果均高于治疗前,差异均有统计学意义(P0.01),且两组疗效比较差异有统计学意义(P0.01)。结论引导式教育疗法能显著提高脑瘫患儿运动功能、生活自理能力、语言沟通能力、认知学习能力等综合能力。     

广西壮族自治区一市二县低出生体重与小儿脑性瘫痪的关系分析

目的：探讨低出生体重与小儿脑性瘫痪（简称脑瘫）的关系。方法：1998年5－12月在南宁市、横县、钦州市钦北区（原钦州县）进行以多（镇）为单位整群抽样调查，对抽样乡（镇）全部1－6岁儿童进行脑瘫患病状况调查。由经过统一培训合格的儿科医生参加现场工作。结果；共调查1－6岁小儿150806人，确诊脑瘫193例，脑瘫发病率1．28‰。低出血体重1450例，发生脑瘫61例，脑瘫发病率42．07‰；正常出生体重148599人，发生脑瘫125例，脑瘫发病率0．84‰。两者差异有非常显著性，且出生体重越低脑瘫发病率越高，呈负相关。61例低出生体重的脑瘫患儿，母孕期在环境、营养方面1／3有营养不良因素；26例（42．6％）有妊娠合并症；38例（62．3％）新生儿期患病；20例（32．8％）母既往有异常孕产史或早产史。结论：低出生体重是与脑瘫高度关联的危险因素。它们在孕期有相似的病因，应加强病因研究以及预防脑瘫，对低出生体重力进行重点护理，防止新生儿患病，也是干预脑瘫发生的措施之一。     

整体观念在儿童脑性瘫痪康复中的应用探讨

通过对儿童脑性瘫痪(简称脑瘫)康复中整体观念的具体化分析和总结,探讨整体观念在儿童脑性瘫痪(康复中的应用和现实指导意义.基于"生物-心理-社会-自然"的现代康复医学模式,儿童脑瘫康复中也体现着整体观念,整体观念也指导着脑瘫康复理论发展和临床应用,整体观念贯穿于整个儿童脑瘫康复过程中,具有现实指导价值.     

痉挛型脑性瘫痪14例腓肠肌超声影像改变

目的观察痉挛型脑性瘫痪(简称脑瘫)患儿腓肠肌超声影像改变。方法选取14例痉挛型脑瘫患儿腓肠肌,采用Aloka-α10超声诊断仪进行超声探测,探测超声下肌纤维结构及肌肉回声改变。结果超声探测发现14例痉挛型脑瘫患儿腓肠肌肌纤维结构和肌肉回声影像有不同程度的改变。结论超声影像技术可以作为评估痉挛性脑瘫患儿腓肠肌变化的检查方法之一。     

低出生体重与脑性瘫痪

目的　确定不同出生体重脑性瘫痪患病率。　方法　１９９７ 年５ 月至６ 月在江苏南部七个市进行了０～６ 岁小儿脑性瘫痪现况调查。　结果　随着出生体重的增加,脑性瘫痪患病率呈现出下降、平台和上升三种变化。出生体重在３ ５００ ～３ ９９９ ｇ 组的脑性瘫痪患病率最低。低出生体重儿（ ＜２ ５００ ｇ）占全部儿童的２－０％ ,而在脑性瘫痪患儿中低出生体重儿却占２４％ 。低出生体重儿脑性瘫痪患病率为１９－４‰（９５％ 可信区间：１６－３‰～２２ ．５ ‰）,而正常出生体重儿（ ≥２ ５００ ｇ） 为１－２‰（９５ ％ 可信区间：１－１ ‰～１ ．３‰）;低出生体重儿脑性瘫痪患病率是正常出生体重儿的１６ 倍（ＲＲ＝１６－１,９５％ 可信区间：１３－４ ～１９－４）。　结论　低出生体重儿脑性瘫痪患病率明显高于正常出生体重儿;调查地区出生体重不足２ ０００ ｇ 的儿童的存活质量有待进一步提高;随着低出生体重儿存活率的上升,脑瘫患病率可能会呈上升趋势。     

脑性瘫痪患儿语言障碍的诊治新进展

近十年来对脑瘫患儿伴随语言语言障碍的研究已引起普遍关注,并取得一定进展,国内外主要从其发生的原因、特点及治疗几个方面着手研究。语言脑区受到损伤,且常合并其他障碍是导致脑瘫患儿语言障碍的主要原因;其主要临床表现为构音障碍和语言发育迟缓;S-S法和Gesell发展量表是语言发育迟缓检查常用的测量量表;在相关治疗方面,祖国传统医学发挥着独特的治疗作用。     

我国小儿脑性瘫痪康复方面应关注的几个问题

【编者按】本刊2009年开设“专家答疑栏目”后,陆续收到了多位读者来信。其中,湖北省阳新县人民医院儿科陈绪文医生来信提出了小儿脑瘫的相关问题。就此,编辑部先后征询了国内儿科神经领域多位资深专家意见,大家一致认为,国内关于脑瘫定义、分型及治疗方面存在争议,有必要通过本刊清晰阐述脑瘫定义及统一对脑瘫定义涵义的理解,区分混淆的概念,明确当前适用的脑瘫分型方法,正确引导、及时纠正脑瘫康复治疗中的一些偏颇和问题。为此,本刊特邀请中国康复医学会儿童康复专业委员会常务理事及主任委员、中国残疾人康复协会常务理事、小儿脑瘫康复专业委员主任委员、我国著名小儿脑瘫及社区康复专家,现任佳木斯大学康复医学院院长的李晓捷教授执笔,对当前脑瘫康复方面应该关注的几个问题作以阐释。我国脑性瘫痪（简称脑瘫）康复起步较晚,始于上世纪80年代初,虽然近10年来呈现出快速发展的趋势,但脑瘫康复的理念、理论、技术、专业队伍素质、康复服务质量等尚不十分成熟,与发达国家相比还有一定差距。目前,我国小儿脑瘫康复既面临着需求剧增而服务相对滞后的现状,也存在着一些亟待统一认识的热点问题,以下就几个热点问题进行讨论,仅供读者参考。     

Establishing the diagnosis of cerebral palsy

Cerebral palsy (CP) is a diagnosis of considerable concern to obstetricians, but the diagnosis of CP can be challenging, and may need to be confirmed by an experienced practitioner, ideally a child neurologist or psychiatrist. It is important not to make the diagnosis too early in infancy, especially when the signs are not severe, as resolution of early neuromotor abnormalities does occur, particularly in premature infants. Exclusion of genetic/metabolic disorders presenting with CP-like findings is important. The degree of activity limitation should be characterized; labeling children as having CP on the basis of abnormal examination findings alone without evidence of activity limitation is not useful. Brain imaging can be helpful in pinpointing the location of the underlying brain abnormality and sometimes provides etiologically useful information.     

Imaging for diagnosis and treatment of cerebral palsy

Neuroimaging, particularly with magnetic resonance techniques, can provide insight into the pattern and severity of cerebral injury underlying cerebral palsy providing a neuroanatomic understanding of the motor and related deficits. Early identification of injury before the establishment of marked motor deficits provides an opportunity for neuroprotection. Neuroimaging provides a robust manner for early delineation of the risk and nature of cerebral palsy that an infant may face. In the future, imaging may provide more functional methods, including novel methods such as optical tomography, map regeneration, adaptation, and functional recovery.     

The incidence of cerebral palsy.

The clinician is often held responsible for obstetric events that are suspected of being related to cerebral palsy. To review the incidence of cerebral palsy and to aid the clinician in this situation, a search of published studies was conducted. Composite rates of cerebral palsy in different birth weight infants and cerebral palsy with and without serious mental retardation were calculated. The cumulative incidence rate at the age of 5 to 7 years was 2.7 cases of cerebral palsy for 1000 birth cohorts. Approximately 36% of all cerebral palsy occurred in the infant less than 2500 gm. Serious mental retardation (intelligence quotient less than 50) accompanied cerebral palsy approximately 30% of the time for the term infant and 18% of the time when the infant was less than 2500 gm. On the basis of a past estimation that 70% of cerebral palsy is of antepartum or unknown origin, the term infant at risk for intrapartum-attributed cerebral palsy may be about 1 in 2000 term births.     

Changing diagnosis of cerebral palsy in very low birthweight children

The stability of the diagnosis of cerebral palsy from 2 to 5 years of age was examined in 83 children of birthweight under 1000 gm, and 112 of birthweight 1000 to 1500 gm. In 20 2-year-old children with cerebral palsy, the diagnosis persisted in 11 (55%, 95% confidence intervals 35.1 to 76.9%); 2 of 175 children (1.1%) free of cerebral palsy at 2 years of age subsequently developed the condition. Severe or moderate cerebral palsy at 2 years persisted in all eight children (100%). In 9 of 12 children in whom cerebral palsy at 2 years had disappeared by 5 years, minor neurologic abnormalities and left-hand preference occurred frequently but mean psychologic tests scores were similar to children always free of cerebral palsy. In this cohort, cerebral palsy at 2 years was not a static condition, but overestimated later prevalence.     

Obstetric factors in cerebral palsy.

A study was carried out on the patient population of two cerebral palsy facilities serving Northeast New York State to evaluate obstetric factors which might be associated with the development of cerebral palsy. A combination of available medical records and a maternal questionnaire was used for analysis. Of 605 contracted, 158 mothers (26%) provided valid and detailed data, and the study was confined to these 158 patients. A positive association was found with increased reproductive loss, prematurity, and vaginal breech delivery. The need to develop and adopt a comprehensive uniform record system for the pregnant patient and her child is underscored. The limitations of a single factor retrospective study are acknowledged.     

1323例小儿脑性瘫痪临床类型与并发症调查研究

目的对1 323例小儿脑性瘫痪(简称脑瘫)临床类型、并发症进行调查研究。方法 2013年1月至2016年10月对辽宁省3~14岁脑瘫患儿1 323例的临床分型及并发症进行调查分析。结果脑瘫类型以痉挛型为最多,其次为肌张力低下型、不随意运动型、混合型以及共济失调型。不同年龄段在临床类型分布中差异有统计学意义(P0.01)。除听力障碍并发症外,不同类型脑瘫并发症发生率比较差异有统计学意义(P0.05)。其中混合型智力落后发生率显著高于其他类型,其次为痉挛型、共济失调型、肌张力低下型、不随意运动型;视力障碍及听力障碍发生率以共济失调型最多;语言障碍、惊厥或癫痫以及行为异常的发生率以混合型为最多。结论各临床类型中智力落后与语言落后发病率最高,临床类型与并发症存在一定内在联系。     

Etiology of cerebral palsy

AIMS: To register the prevalence of cerebral palsy (CP) and determine etiological factors for the condition. METHODS: Population based study with registration of CP-cases in children born during the 30-year period 1970-99. Cases with postneonatal etiology were excluded. RESULTS: 166 CP-cases were registered among 70 824 children, a prevalence of 2.3 per 1000 live born infants. The prevalence did not change significantly during the period. 66 (40%) were low birthweight infants (LBWIs; <2500 g), and 100 (60%) normal birthweight infants (NBWIs; > or = 2500 g). The origin was classified as prenatal in 37 (22%), perinatal/neonatal in 78 (47%) and unclassifiable in 51 (31 %). In LBWIs 39/66 (59%) had a perinatal/neonatal etiology, most frequently intra- or periventricular hemorrhages (IVH/PVH) and/or periventricular leukomalacia (PVL) or cerebral infarctions (CI) (17; 44%). In NBWIs 39/100 (39%) had a perinatal etiology, most frequently hypoxic-ischemic encephalopathy (HIE) (31; 79%). CONCLUSIONS: In a substantial percentage of CP-cases perinatal/neonatal brain injury was classified as the cause. Among these IVH/PVH/PVL/CI dominated in LBWIs, while HIE dominated in NBWIs. Our data may point to preventability of a larger part of CP than earlier suggested.