细化全身运动评估分期在脑损伤高危儿随访管理中的应用价值  

Application value of detailed general movements assessment stages in follow-up management of high-risk infants of brain injury

作　　者：蔡荣兰[1] 杜正银[2] 吴尚 蔡娟[1] 陈娟娟[1] 杨丽娟[1] CAI Rong-lan;DU Zheng-yin;WU Shang;CAI Juan;CHEN Juan-juan;YANG Li-juan(Department of Children's Rehabilitation,the First Affiliated Hospital of Bengbu Medical College,Bengbu,Anhui 233004,China;不详)

机构地区：[1]蚌埠医学院第一附属医院儿科康复部,安徽蚌埠233004 [2]怀远县中医院儿科 [3]固镇县人民医院儿科

出　　处：《中国妇幼保健》2024年第9期1596-1599,共4页Maternal and Child Health Care of China

基　　金：蚌埠医学院自然科学重点项目(2020byzd084)。

摘　　要：目的 探讨细化全身运动评估分期在脑损伤高危儿随访管理中的应用价值,为构建规范、高效的高危儿随访管理模式提供理论依据。方法 选取2020年1月—2021年6月在蚌埠医学院第一附属医院儿科门诊随访的132例高危儿为研究对象,共进行全身运动评估200次。按细化全身运动周龄,将第一阶段(扭动运动阶段),分为全身运动周龄<0周组和全身运动周龄≥0周组,再细分为4期;第二阶段(不安运动阶段)分为早期、中期、晚期3期。分析高危儿随访时间的分布规律,以及各型全身运动结果与细化分期之间的相关性。结果 第一阶段评估128例次,4例次(3.13%)为早产及扭动阶段正常全身运动(N);124例次为异常,包括80例次(62.50%)单调性全身运动(PR),4例次(3.13%)混乱性全身运动(Ch),40例次(31.25%)痉挛-同步性全身运动(CS)。两组CS和PR比例比较差异均无统计学意义(χ^(2)=2.85,1.42,均P>0.05)。细化全身运动0周以前,随访频次较低(0.11次/例);细化全身运动0周以后(含0周),随访频次明显增高(3.03次/例)。第二阶段评估72例次,32例次(44.44%)正常不安运动(NF),18例次(25.00%)异常不安运动(AF),22例次(30.56%)不安运动缺乏(F-)。第二阶段早、中、晚3期,细化各类全身运动评估结果分布比较差异有统计学意义(χ^(2)=20.12,P<0.05)。结论 细化全身运动分期有利于选择评估关键期(细化全身运动周龄:-6周、0周、13周、16周),提高结果阳性率,提高对高危儿神经发育结局的预测价值。以关键期综合评估为基础,结合NICU内以及线上全身运动评估的随访模式,是一条高效、经济、规范的高危儿健康管理模式。Objective To explore the application value of detailed general movements(GMs) assessment stages in follow-up management of high-risk infants of brain injury, and provide theoretical basis for the construction of standardized and efficient follow-up management model of high-risk infants.Methods A total of 200 times of GMs were evaluated in 132 high-risk infants of brain injury who were followed up in Pediatric Outpatient Department of the First Affiliated Hospital of Bengbu Medical College.According to GMs week age, the first stage(preterm and writhing stage) was divided into two groups and further divided into four periods;the second stage(fidgety movements stage) was divided into three periods.The distribution of follow-up time of high-risk infants and the correlation between the results of GMs and the onset period were analyzed.Results In the first stage, 128 times were evaluated.the proportion of normal GMs(N) was 3.13%(4 times), 124 times were abnormal GMs, including PR(80 times, 62.50%), Ch(4 times, 3.13%), and CS(40 times, 31.25%).There was no significant difference in the frequencies of CS and PR(χ^(2)=2.85,1.42, P>0.05).The frequency of follow-up before GMs 0 week was low(0.11 times per case), after GMs 0 week, the frequency was high(3.03 times per case).In the second stage, 72 times were evaluated.The proportion of NF was 44.44%(32 times), the proportion of AF was 25.00%(18 times), the proportion of F-was 30.56%(22 times).There was significant difference in the frequency of detailed GMs among early, middle, and late stages(χ^(2)=20.12, P<0.05).Conclusion Detailed GMs stage is beneficial to choose the critical period of assessment(GMS-6,0, 13, and 16 weeks), improve positive rate of results and the predictive value of neurodevelopmental outcomes in high-risk infants.The follow-up model based on the comprehensive assessment of critical period, combined with intra-NICU GMs assessment and online GMs assessment, is an efficient, economical, and standardized health management system for high-risk infants.

关 键 词：全身运动评估 细化分期 脑损伤高危儿 随访管理 

分 类 号：R725[医药卫生—儿科]