超早期综合康复干预对高危儿神经发育预后的影响
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摘要
目的:观察超早期综合康复干预对早产高危儿神经发育预后的影响。方法:将符合纳入标准的早产高危儿按照家长意愿分为对照组(n=30)和治疗组(n=30)。对照组给予常规治疗,治疗组在对照组的基础上给予综合康复治疗,两组患者疗程均为10日。分别观察两组患儿体重、奶量、NBNA评分、GMFM评分和Gesell评分的变化。结果:治疗组治疗后体重、奶量均较治疗前显著增加(P<0.01),明显优于对照组(P<0.01);治疗组患儿满40周时NBNA评分高于对照组(P<0.05),NBNA异常率低于对照组(P<0.01);治疗组出生后1个月、2个月、3个月A能区和B能区GMFM评分和社会适应、大运动、精细运动、语言和个人社交5个维度均显著增加,明显优于对照组(P<0.05或P<0.01)。结论:超早期综合康复能够改善高危儿的身体素质,促进神经系统的发育,疗效显著。
Objective:To observe the effect of super-early comprehensive rehabilitation intervention on neurodevelopmental prognosis of premature high-risk infants.Methods:Premature high-risk infants who met the inclusion criteria were divided into control group(n=30)and treatment group(n=30)according to parental willingness.The control group was given routine treatment,while the treatment group was treated with comprehensive rehabilitationon the basis of the control group.The course of treatment for both groups was 10 days.The changes of body weight,milk consumption,NBNA score,GMFM score and Gesell score were observed.Results:After treatment,the body weight and milk consumption of the treatment group significantly increased compared with those before treatment(P<0.01),and they weresignificantly better than thoseof the control group(P<0.01);the NBNA score of the treatment group was higher than that of the control group at 40 weeks of gestational age(P<0.05),and the abnormal rate of NBNA was lower than that of the control group(P<0.01).The GMFM scores of A-energy and B-energy areas and the five dimensions of social adaptation,big exercise,fine exercise,language and personal social interactionin the treatment groupsignificantlyincreased in 1 month,2 months and 3 months after birth,which were significantly better than those in the control group(P<0.05 or P<0.01).Conclusion:Super-early comprehensive rehabilitation can improve the physical quality of high-risk infants and promote the development of the nervous system,and the curative effectis remarkable.
Objective:To observe the effect of super-early comprehensive rehabilitation intervention on neurodevelopmental prognosis of premature high-risk infants.Methods:Premature high-risk infants who met the inclusion criteria were divided into control group(n=30)and treatment group(n=30)according to parental willingness.The control group was given routine treatment,while the treatment group was treated with comprehensive rehabilitationon the basis of the control group.The course of treatment for both groups was 10 days.The changes of body weight,milk consumption,NBNA score,GMFM score and Gesell score were observed.Results:After treatment,the body weight and milk consumption of the treatment group significantly increased compared with those before treatment(P<0.01),and they weresignificantly better than thoseof the control group(P<0.01);the NBNA score of the treatment group was higher than that of the control group at 40 weeks of gestational age(P<0.05),and the abnormal rate of NBNA was lower than that of the control group(P<0.01).The GMFM scores of A-energy and B-energy areas and the five dimensions of social adaptation,big exercise,fine exercise,language and personal social interactionin the treatment groupsignificantlyincreased in 1 month,2 months and 3 months after birth,which were significantly better than those in the control group(P<0.05 or P<0.01).Conclusion:Super-early comprehensive rehabilitation can improve the physical quality of high-risk infants and promote the development of the nervous system,and the curative effectis remarkable.
引文
1邹林霞,林小苗,陈维华,等.基于NICU环境的早期干预对早产高危儿神经发育结局的影响[J].中国康复,2017,32(2):136-137.
2 Olivieri I,Bova SM,Urgesi C,et al.Outcome of extremely low birth weight infants:What's new in the third millennium?Neuropsychological profiles at four years[J].Early HumDev,2012,87(10):241-250.
3刘敬,杨于嘉,封志纯."早产儿脑损伤诊断与防治专家共识"解读[J].中国当代儿科杂志,2012,14(7):885-887.
4郑文,倪照凤.高危儿早期干预的理论与实践[J].当代医学,2014,20(1):15-16.
5周蕾,蔡勇,梁少珍,等.早产儿出院后1年随访管理及早期干预对其神经、生长发育的影响[J].广东医学,2018,39(21):3237-3240,3244.
6张庆华,余妙玲.超早期康复治疗配合常规药物对高危儿神经心理发育的影响[J].中国药物经济学,2018,13(5):31-34.
7袁嫣然,周瑞刚,邓继红,等.超早期康复治疗对高危儿神经心理发育影响的临床研究[J].现代生物医学进展,2017,17(8):1530-1533.
8邢珊,刘俐,李改莲,等.NBNA评分在评价早产儿脑发育、脑损伤及预后中的应用[J].中国儿童保健杂志,2016,24(2):191-194.
9史惟,杨红,王素绢,等.1-6岁不同级别脑瘫患儿粗大运动功能发育的研究[J].中国康复理论与实践,2009,15(9):815-818.
10徐世琴,吴晓丽.Gesell发育量表在婴幼儿脑瘫治疗评估中的价值[J].中国妇幼保健,2017,32(8):1685-1687.
11王晓琴,王莹,李红.早产儿脑损伤的危险因素[J].中国新生儿科杂志,2015,30(4):286-288.
12刘彩霞,景卫莉,谢集建.早产儿脑损伤发病机制研究进展[J].医学综述,2015,21(9):1638-1640.
13刘艳兵,喻云,陈晓.早产儿脑白质损伤发病机制的研究进展[J].南昌大学学报(医学版),2013,53(2):97-100.
14段毅敏,江利群.早期发育支持对早产儿体格及智力发育的影响[J].中国妇幼保健,2015,30(8):1198-1200.
15余章斌,韩树萍,邱玉芳,等.系统评价早产对儿童智力发育的影响及早期干预作用[J].中国循证儿科杂志,2012,7(2):113-119.
16刘秀梅,初清,李丽霞,等.早产儿婴儿期神经行为发育随访结果分析[J].中国妇幼保健,2010,25(29):4210-4212.
17 Orton J,Spittle A,Doyle L,et al.Do early interventionprogrammes improve cognitive and motor outcomes for preterminfants after discharge?A systematic review[J].Dev Med ChildNeurol,2009,51(11):851-859.
18 Parker J,Mitchell A,Kalpakidou A,et al.Cerebellar growth andbehavioural&neuropsychological outcome in preterm adolescents[J].Brain,2008,131(5):1344-1351.
19鲍珊,陈大鹏,杨晓燕,等.我国早产儿脑损伤研究现状-基于国内期刊的共词分析[J].中国新生儿科杂志,2013,28(6):366-370.
20杨卓欣,于海波,罗广舒,等.针刺任脉和督脉对脑缺血大鼠海马星形胶质细胞的影响[J].针刺研究,2008,31(5):7-9.
21苏珍辉,张惠佳,丁玉莲,等.应用Rood技术改善脑损伤综合征患儿的运动功能障碍[J].中国临床康复,2005(27):174-175.
22徐宁,张金桥,常燕群,等.Rood疗法对重度窒息新生儿神经行为能力的影响[J].中国妇幼卫生杂志,2012,3(2):105-106.
2 Olivieri I,Bova SM,Urgesi C,et al.Outcome of extremely low birth weight infants:What's new in the third millennium?Neuropsychological profiles at four years[J].Early HumDev,2012,87(10):241-250.
3刘敬,杨于嘉,封志纯."早产儿脑损伤诊断与防治专家共识"解读[J].中国当代儿科杂志,2012,14(7):885-887.
4郑文,倪照凤.高危儿早期干预的理论与实践[J].当代医学,2014,20(1):15-16.
5周蕾,蔡勇,梁少珍,等.早产儿出院后1年随访管理及早期干预对其神经、生长发育的影响[J].广东医学,2018,39(21):3237-3240,3244.
6张庆华,余妙玲.超早期康复治疗配合常规药物对高危儿神经心理发育的影响[J].中国药物经济学,2018,13(5):31-34.
7袁嫣然,周瑞刚,邓继红,等.超早期康复治疗对高危儿神经心理发育影响的临床研究[J].现代生物医学进展,2017,17(8):1530-1533.
8邢珊,刘俐,李改莲,等.NBNA评分在评价早产儿脑发育、脑损伤及预后中的应用[J].中国儿童保健杂志,2016,24(2):191-194.
9史惟,杨红,王素绢,等.1-6岁不同级别脑瘫患儿粗大运动功能发育的研究[J].中国康复理论与实践,2009,15(9):815-818.
10徐世琴,吴晓丽.Gesell发育量表在婴幼儿脑瘫治疗评估中的价值[J].中国妇幼保健,2017,32(8):1685-1687.
11王晓琴,王莹,李红.早产儿脑损伤的危险因素[J].中国新生儿科杂志,2015,30(4):286-288.
12刘彩霞,景卫莉,谢集建.早产儿脑损伤发病机制研究进展[J].医学综述,2015,21(9):1638-1640.
13刘艳兵,喻云,陈晓.早产儿脑白质损伤发病机制的研究进展[J].南昌大学学报(医学版),2013,53(2):97-100.
14段毅敏,江利群.早期发育支持对早产儿体格及智力发育的影响[J].中国妇幼保健,2015,30(8):1198-1200.
15余章斌,韩树萍,邱玉芳,等.系统评价早产对儿童智力发育的影响及早期干预作用[J].中国循证儿科杂志,2012,7(2):113-119.
16刘秀梅,初清,李丽霞,等.早产儿婴儿期神经行为发育随访结果分析[J].中国妇幼保健,2010,25(29):4210-4212.
17 Orton J,Spittle A,Doyle L,et al.Do early interventionprogrammes improve cognitive and motor outcomes for preterminfants after discharge?A systematic review[J].Dev Med ChildNeurol,2009,51(11):851-859.
18 Parker J,Mitchell A,Kalpakidou A,et al.Cerebellar growth andbehavioural&neuropsychological outcome in preterm adolescents[J].Brain,2008,131(5):1344-1351.
19鲍珊,陈大鹏,杨晓燕,等.我国早产儿脑损伤研究现状-基于国内期刊的共词分析[J].中国新生儿科杂志,2013,28(6):366-370.
20杨卓欣,于海波,罗广舒,等.针刺任脉和督脉对脑缺血大鼠海马星形胶质细胞的影响[J].针刺研究,2008,31(5):7-9.
21苏珍辉,张惠佳,丁玉莲,等.应用Rood技术改善脑损伤综合征患儿的运动功能障碍[J].中国临床康复,2005(27):174-175.
22徐宁,张金桥,常燕群,等.Rood疗法对重度窒息新生儿神经行为能力的影响[J].中国妇幼卫生杂志,2012,3(2):105-106.