640例脑性瘫痪的诊断探讨

目的探讨脑性瘫痪的诊断以利防治。方法对南京市儿童医院早期干预门诊确诊的640例脑患儿［早产儿258例(早产儿组)，足月儿382例(足月儿组)］分析其病因、早期临床表现及头颅CT征象，进行体格神经系统检查并智测。结果(1)高危因素，两组在颅内出血、肺部疾病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均<0.05外余P均>0.05。(2)6个月以内确诊早产儿、足月儿两组各为28、90例的临床表现，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。(3)早产儿、足月儿两组的身长、体重、头围、MDI和PDI各为73.24±9.82、73.58±11.64(cm)，9.12±2.31、9.23±2.80(kg)，44.15±3.47、42.99±4.23(cm)，44.42±6.09、41.99±7.28(分)，43.81±4.95、40.80±4.51(分)。(4)头颅CT表现。早产儿、足月儿两组CT异常率各为95.4%及89.8%，P<0.05。(5)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干预。

Exploration of the diagnosis of 640 cases of cerebral palsy.

AbstractObjectiveTo explore the early diagnosis of cerebral palsy.MethodsA total of 640 cases of diagnosed cerebral palsy were divided 2 groups.They were 258 premature infants(PI) group and 382 mature infants(MI) group.Physical neurological examination,intelligence test(CDCC) and cranial CT examination were given to each case.Results1.High risk factors group(PI) was higher than MI group in intracranial hemorrhage and pulmonary disease but MI group was higher than group PI in hypoxic ischemic encephalophathy (P all were <0.05),others P all were>0.05.2.The clinical features of cerebral palsy of those diagnosed within 6 monthes in groups PI and MI were shown in 28 and 70 cases respectively.Group PI was more severe than group MI in poor feeding、crying、moving、less reaction and hypotonic but group MI was more severe than group PI in being noisy whole day、nursy difficulty and hypertonic,P all were <0.05 and <0.01,others P all were >0.05.3.Physical and intelligence developments:Group PI and MI in body length(cm)、body weight(kg)、head circumference(cm),MDI and PDI(mark) were 73.24±9.82、73.58±11.64、9.12±2.31、9.23±2.80、44.15±3.47、42.99±4.23、44.42±6.09、41.99±7.28、43.81±4.95、40.80±4.51 respectively.4. The abnormality features of cranial CT scan was 95% in group PI and 89.8% in group MI P<0.05.5.Retardation:Group PI was more SEVERE than group MI in language retardation,group MI was more severe than group PI in body length(<2SD),P all were<0.05.ConclusionThe cerebral palsy can be early diagnosed by infant with high risk factors,abnormal physical intelligence development,neurological manifestation and abnormal cranial CT.Once diagnosis is done,early intervention should be given.