早期评估及干预在脑性瘫痪高危儿运动发育中的应用  

Application of early assessment and intervention in motor development of high-risk infants with cerebral palsy

作　　者：张亚楠 吴丽 任麦青 马艳丽 Zhang Yanan;Wu Li;Ren Maiqing;Ma Yanli(Department of Child Rehabilitation,Zhengzhou Central Hospital Affiliated to Zhengzhou University,Zhengzhou 450000,China)

机构地区：[1]郑州大学附属郑州中心医院儿童康复科,450000

出　　处：《中华实用儿科临床杂志》2021年第24期1891-1895,共5页Chinese Journal of Applied Clinical Pediatrics

基　　金：郑州市科学技术局项目(20140444)。

摘　　要：目的评价全身运动质量评估(GMs)早期预测脑性瘫痪(脑瘫)高危儿神经发育结局的临床价值,分析Peabody粗大运动发育量表(PDMS-GM)与粗大运动功能测试量表(GMFM)对脑瘫高危儿康复评估及干预的应用研究。方法采用PDMS-GM和GMFM 2种评估方法对2017年1月至2019年12月在郑州大学附属郑州中心医院儿童康复科住院治疗的GMs评估结果异常的64例脑瘫高危儿治疗前及治疗2个月后的粗大运动功能进行评估,比较治疗前后PDMS-GM总百分比和GMFM总百分比的变化程度、PDMS-GM月相对百分比和GMFM月相对百分比的差异有无统计学意义,分析治疗前扭动运动阶段和不安运动阶段PDMS-GM与GMFM原始分的相关性、治疗前后PDMS-GM和GMFM原始分的相关性,随访脑瘫高危儿至1岁左右,根据临床诊断及评估结果确定其神经发育结局,评价GMs对脑瘫结局的预测价值。结果与治疗前比较,脑瘫高危儿治疗后PDMS-GM和GMFM总百分比均明显提高[PDMS-GM:(37.250±13.690)%比(20.992±10.273)%,t=-15.793,P<0.01;GMFM:(22.672±8.438)%比(10.601±7.890)%,t=-16.442,P<0.01];治疗前扭动运动阶段和不安运动阶段的PDMS-GM与GMFM原始分之间均具有较高的相关性(扭动运动阶段:r=0.922,P<0.01;不安运动阶段:r=0.905,P<0.01);治疗前后PDMS-GM和GMFM原始分之间具有较高的相关性(治疗前:r=0.901,P<0.01;治疗后:r=0.801,P<0.01);PDMS-GM月相对百分比[(97.286±88.330)%]和GMFM月相对百分比[(76.885±43.815)%]的差异无统计学意义(t=-1.656,P=0.103);GMs评估扭动运动阶段对脑瘫结局预测的敏感性为90.7%、特异性为82.3%、阳性预测值为23.4%、阴性预测值95.8%;GMs评估不安运动阶段对脑瘫结局预测的敏感性为98.3%、特异性为88.1%、阳性预测值为27.6%、阴性预测值为96.8%。对脑瘫高危儿1岁随访时共出现3例痉挛型脑瘫,1例GMs评估结果为痉挛同步性,2例GMs评估结果为不安运动缺乏。结论治疗后脑瘫高危儿粗大运动功�Objective To evaluate the clinical value of the General Movements(GMs)in predicting the neurological outcome of high-risk infants with cerebral palsy in the early stage,and to analyze the application of the Peabody Developmental Motor Scale-Gross Motor(PDMS-GM)and Gross Motor Function Measure Scale(GMFM)in the rehabilitation assessment and intervention of high-risk infants with cerebral palsy.Methods The gross motor function of 64 high-risk infants with cerebral palsy before treatment and after 2 months of treatment in Department of Child Rehabilitation,Zhengzhou Central Hospital Affiliated to Zhengzhou University from January 2017 to December 2019 was evaluated using PDMS-GM and GMFM.The total percentage of PDMS-GM and GMFM before and after treatment,and the monthly relative percentage of PDMS-GM and GMFM were compared.The correlation between PDMS-GM and GMFM original scores in the writhing and fidgety movements period before treatment,and that between PDMS-GM and GMFM original scores before and after treatment were compared.High-risk infants with cerebral palsy were followed up to 1 year old,and their neurological outcome was determined according to the clinical diagnosis and evaluation results.The predictive value of GMs on the outcome of cerebral palsy was evaluated.Results Compared with that before treatment,the total percentage of PDMS-GM and GMFM in high-risk infants with cerebral palsy increased significantly after treatment[PDMS-GM:(37.250±13.690)%vs.(20.992±10.273)%,t=-15.793,P<0.01;GMFM:(22.672±8.438)%vs.(10.601±7.890)%,t=-16.442,P<0.01].PDMS-GM original scores in the writhing movements period and fidgety movements period before treatment were highly correlated with those of GMFM(writhing movements period:r=0.922,P<0.01;fidgety movements period:r=0.905,P<0.01).PDMS-GM original score before and after treatment were highly correlated with those of GMFM(before treatment:r=0.901,P<0.01;after treatment:r=0.801,P<0.01).There was no significant difference in the monthly relative percentage of PDMS-GM and

关 键 词：Peabody粗大运动发育量表 粗大运动功能测试量表 全身运动质量评估 脑性瘫痪高危儿 

分 类 号：R742.3[医药卫生—神经病学与精神病学] R493[医药卫生—临床医学]