早期干预对缺氧缺血性脑病患儿扭动运动的影响

目的探讨早期干预对缺氧缺血性脑病(hypoxic-ischemic encephalopathy,HIE)患儿扭动运动阶段全身运动质量(general movements,GMs)的影响,以在临床上指导HIE患儿进行早期干预,提高神经发育预后。方法 1)以2011年10月-2014年6月在儿保门诊随诊的327例扭动阶段HIE患儿为研究对象。随机分为早期干预组(n=168),观察对照组(n=159)。各组患儿根据HIE损伤程度不同,分为轻度HIE组、中度HIE组、重度HIE组。2)早期干预:对婴儿直接干预和指导家长进行干预相结合。3)比较各组患儿扭动阶段不同GMs结果数量。结果早期干预组,正常扭动运动数量明显多于观察对照组(χ2=16.017,P=0.000),而早期干预组单调性扭动运动(χ2=10.169,P=0.001)、痉挛-同步性扭动运动(χ2=4.246,P=0.039)数量均明显少于观察对照组;根据HIE患儿损伤程度分组后,轻度HIE组和中度HIE组,早期干预组扭动运动均多于观察对照组(χ2=10.321,P=0.001;χ2=9.227,P=0.002),PR均少于观察对照组(χ2=10.321,P=0.001;χ2=4.490,P=0.034)。重度HIE组,两组间N、PR、CS差异无统计学意义。结论早期干预可降低轻度HIE、中度HIE组患儿单调性扭动运动发生率,提高正常扭动运动发生率;重度HIE患儿早期干预效果不明显。

Effect of early intervention on hypoxic-ischemic encephalopathy infants' writhing movements

Objective To investigate effects of early intervention on hypoxic-ischemic encephalopathy (HIE) infants' writhing movements,guide early clinical intervention for HIE infants and improve neuro developmental outcome. Methods 1) The survey was carried among 327 HIE infants during writhing period,following up to well baby clinic,from October 2011 to June 2014.The cases were divided into early intervention group (n=168) and control group (n=159) randomly.Each group was divided into mild HIE group,moderate HIE group,severe HIE group according to damage degree of HIE.2) Early intervention was combined direct intervention and guiding parents for intervention.3)The rate of GMs among each group was compared. Results The number of writhing movement in early intervention group was more than that of the control group (χ²=16.017,P=0.000),while the number of poor repertoire general movements(χ²=10.169,P=0.001) and cramped-sychronised general movements were significantly fewer than those of the control group(χ²=4.246,P=0.039);In mild HIE group and moderate HIE group writhing movements (χ²=10.321,P=0.001;χ²=9.227,P=0.002) and PR (χ²=10.321,P=0.001;χ²=4.490,P=0.034) had significant differences in two groups.In severe HIE group,there were no significant differences in N,PR and CS between the two groups. Conclusion Very early intervention can reduce incidence rate of PR,improve incidence rate of normal writhing movement in mild and moderate HIE group; While there is no effect in severe HIE group.