重症脑瘫240例临床分析

目的 通过对住院康复治疗240例重症脑瘫(cerebral palsy,CP)患儿临床特点进行分析,提高对重症CP的认识,并尽早防治。 方法 对资料完善的240例重症CP患儿围产史、生长发育史、症状、体征、影像学检查、电生理学检查、粗大运动功能评估量表和Peabody精细运动量表评估检查,进行回顾性研究分析。结果 240例CP患儿中痉挛型103例(42.9%),不随意运动型81例(33.8%),混合型49例(20.4%),肌张力低下型7例(2.9%),粗大运动功能分级均在Ⅳ级以上;主要高危致病因素为早产(37.9%),宫内缺氧(20.4%),病理性黄疸(15.8%);90%患儿合并智力低下,44%患儿合并视觉障碍,8.3%合并听觉障碍,27.1%存在症状性癫痫,42.9%患儿因吞咽功能障碍导致营养不良;其大脑形态学损伤以白质容积减少,髓鞘化延迟,脑室周围白质软化,多发性脑软化,脑发育不良,基底节病变为主。 结论重症CP致病因素复杂多样,运动功能严重受限,多伴有一种甚至多种并发障碍,认识这些疾病的高危因素和并发症的损害,有利于更好地防治重症CP。

Clinical analysis of 240 children with severe cerebral palsy

Objective In terms of clinical features as a comprehensive observation and analysis of children with severe cerebral palsy(CP),to determine the efficacy of the results and better prevention. Methods A total of 240 severe CP children were examined by perinatal history,history of growth and development,symptom,signs,imaging studies,electroencephalogram,and Gross Motor Function Measure(GMFM),Peabody Developmental Motor Scale-Fine Scale (PDMS-FM),to detect the clinical features. Result Among the 240 cases of CP,103 cases (42.9%) with spastic type CP,81 cases (33.8%) with dyskinetic type,49 cases(20.4%) with mixed type,7 cases (2.9%) with hypotonia type ,gross motor function classification were than grade Ⅳ;the main risk factors for preterm delivery (37.9%),intrauterine hypoxia (20.4%),neonatal jaundice (15.8%);90% cases with mental retardation,44% cases with visual impairment,8.3% cases with hearing impairment,27.1% cases with symptomatic epilepsy,42.9% patients with swallowing dysfunction lead to malnutrition;brain morphological damage reduced to white matter volume,myelination delay,periventricular leukomalacia,multiple brain softening,cerebral dysplasia,basal ganglia lesions.Conclusion The pathogenic factors of severe cerebral palsy are complex and diversiform;severe CP patients' motor function is severely restricted;with even multiple concurrent disorders.To know these disease risk factors and complications of damage could help us to prevent and treat severe CP better.