320例脑性瘫痪的诊断探讨

目的 探讨脑性瘫痪的准确诊断及治疗。方法 对黑龙江省医院道外分院、哈尔滨市第二医院、黑龙江省林业总医院早期门诊确诊的320例脑瘫患儿早产儿136例（早产儿组），足月儿184例（足月儿组）]分析其病因、早期临床表现、体格神经系统检查，并智测及头颅CT检查。结果 高危因素：两组在颅内出血、肺部疾病方面早产儿组明显高于足月儿组；缺氧缺血性脑病组足月儿明显高于早产儿组，P〈0．05；6个月以内确诊早产儿、足月儿，两组各为21、25例。临床表现：反应差、嗜睡、少吃、少哭、少动，肌张力低下，早产儿组明显高于足月儿组，而不停啼哭，护理困难，肌张力增高，足月儿组明显高于早产儿组，P均〈0．01及0．05，余P均〉0．05；早产儿、足月儿两组的身长、体重、头围、MDI和PDI各为72．58cm±9．42cm、74．16cm±10．31cm，9．24kg±2．54kg、9．37kg±3．15kg，45．06cm±3．52cm、43．15cm±4．33cm，45．17min±7．11min、42．10min±7．35rnin，44．35min±5．13rnin、41．45rnin±4．50min；头颅CT表现：早产儿、足月儿两组CT异常率各为94．46％及86．5％，P〈0．05；发育落后早产儿组言语落后明显高于足月儿组外，足月儿组身长〈2SD，明显高于早产儿组P均〈0．05，余P均〉0．05。结论 当患儿具有高危因素、异常临床表现与神经症状、发育明显落后，应结合头颅CT密切随访，可早期诊断脑性瘫痪，及早期治疗。

Discussion on Diagnosis of Cerebral Palsy

Objective To discuss the accuracy diagnosis and treatment of cerebral palsy.Methods The clinical materials of 320 cases(136 cases premature and 184 cases term infant)of such patient in three hospitals were analyzed in its etiology,early clinical manifestations,nervous system detection and head CT scan.Results The cerebral bleeding and pulmonary disease were higher in premature group than those in term infant group.The hypoxia and ischemic cerebral disease in term infant group was higher than that in premature group P<0.05.The poor clinical manifestations(lethargy,low muscle tension,less motion and cry) in premature group were higher than those in normal group.The difficulty nursing,high muscle tensions in normal group were higher than those in premature group.The length,body weight,headcircumference,MDI,PDI in premature group and normal group were 72.58 cm±9.42 cm,74.16 cm±10.31 cm,9.24 kg±2.54 kg,9.37 kg±3.15 kg,45.06 cm±3.52 cm,43.15 cm±4.33 cm,45.17 min±7.11 min,42.10 min±7.35 min,44.35 min±5.13 min,41.45 min±4.50 min.The abnormality rate in CT scan was 94.46% in premature group and 86.5% in normal group P<0.05.Other had no significant difference between two groups.Conclusion There are high risk factors,abnormal manifestations,nervous symptoms,delayed development and CT that might obtain the early diagnosis and treatment combined with follow up.