儿心量表对新生儿缺氧缺血性脑病患儿监测和康复评价应用研究

发布时间：2018-03-24 18:12

本文选题：儿心量表　切入点：新生儿缺氧缺血性脑病　出处：《河南科技大学》2017年硕士论文

【摘要】：目的:新生儿缺氧缺血性脑病患儿早期干预并非简单的药物治疗,其康复耗费时间长、手段较多、花费大,寻求一种简便易行的便于家长掌握的综合康复手段应用于临床显得非常重要。应用儿心量表观察综合手段介入的不同时间窗检测患儿的发育商并进行分析、研判,以期寻求更有效的综合干预手段及介入时间窗改善新生儿缺氧缺血性脑病患儿远期预后,有望降低致残、致畸等后遗症出现的可能性。重要性:新生儿缺氧缺血性脑病是世界上各国新生儿时期发病率很高的神经系统疾病,患儿病情进展快、死亡率高,是新生儿致伤、残的原因之一。有大量研究表明,国内外对新生儿缺氧缺血性脑病的共识不一致,有研究者进行大量研究认为应该从临床症状、脑组织形态学、脑功能改变、实验室、影像学等进行综合判断,此为临床医师普遍评估预后的方法。另有其他研究显示上述综合判断对新生儿HIE预后的敏感性高,但特异性较低。为了进一步早期、客观评估HIE患儿的预后(包括大运动、精细动作、语言、社交能力、适应能力等),应用儿心量表对患儿脑损伤引起大运动、精细动作、语言等各方面进行量化监测,引入综合治疗措施后在不同月龄进行再评估,即将儿心量表作为监测及康复评价的工具,以期寻找一种便于临床医师及家长共同掌握的干预手段,积极改善预后,降低远期致畸、致残率的发生,并将此治疗手段在临床上推广使用。方法:1.观察组:选取2015年10月2016年02月收住我院儿科住院治疗的174例新生儿缺氧缺血性脑病患儿为观察组,所有患儿均符合HIE诊断标准。在家长知情同意的基础上将患儿进一步随机分为A、B两组:A组88例:给予新生儿期三维持三对症正规治疗,并在第1、2、3个月给予1个疗程的神经节苷酯巩固,在第4个月时引入综合干预措施(抚触、婴儿操、视听觉刺激、手法按摩、心理支持、运动能力刺激等,其中,对于薄弱能区进行针对性强化治疗);B组86例,因HIE患儿最佳治疗时间窗为产后6h,待病情平稳后,在A组的基础上,新生儿期引入综合干预措施;2.对照组:选择同期在医院儿童保健科就诊的80例正常儿童作为对照;3.严格制定纳入和排除标准;4.观察组和对照组在1、2、3、6、9、12个月时进行儿心量表测定,并进行数据收集;结果:本研究显示,排除因各种原因失访和中途退出的研究对象,与B组在新生儿期即开始干预相比,给予A组综合干预措施后的发育商分值相对B组稍低,且在第6个月时发育商分值差别较大,虽与对照组相比智能发育略差,但智能发育趋势相似,对照组婴儿随着年龄的增长,发育商逐渐增加,符合婴幼儿一般生长规律,观察组A组HIE患儿在第4个月之后智能指数虽然有所增高,但与观察组B组存在差异,各时段以及不同组别HIE患儿儿心量表分值存在差异(P0.001),具有统计学意义。结论:通过儿心量表测试得到患儿发育商,能及时发现发育偏离的患儿,为临床早期干预、改善预后、减少患儿伤残提供科学依据;新生儿期引入综合治疗措施,通过儿心量表各个能区量化评估,对薄弱能区进行针对性强化干预治疗,可在一定程度上改善新生儿缺氧缺血性脑病的预后,值得临床推广应用。
[Abstract]:Objective: early intervention of neonatal hypoxic ischemic encephalopathy is not a simple drug treatment, the recovery takes a long time, means more expensive for parents to master the application of comprehensive rehabilitation methods for a simple and easy for clinical application is very important. Different time window scale observation of comprehensive intervention of children with developmental detection means taking and analyzed, judged, in order to seek a more effective comprehensive intervention and intervention time window to improve the neonatal hypoxic ischemic encephalopathy prognosis, is expected to reduce the possibility of disability, teratogenic and other sequelae. Importance: neonatal hypoxic-ischemic encephalopathy is the world's countries in the neonatal period the incidence of diseases of the nervous system is very high, with the progress of the disease fast, high mortality, neonatal injury, one of the reasons for disability. There is a lot of research shows that the neonatal hypoxia ischemia at home and abroad Encephalopathy consensus is not consistent, researchers have made a large number of studies suggest that it should be from the clinical symptoms, brain morphology, brain function, laboratory, comprehensive judgment imaging, the general prognosis assessment method for clinicians. Other research shows that the comprehensive judgment of the prognosis of neonatal HIE high sensitivity, but specificity in order to further lower the early prognosis objective evaluation with HIE (including sports, fine motor, language, social skills, adaptability, etc.) using the child heart scale caused by large movement of brain injury in children with fine motor, language and other aspects of quantitative monitoring, comprehensive treatment measures were introduced in different months age is the child heart scale assessment, monitoring and rehabilitation as an evaluation tool, in order to find a common master for clinicians and parents of intervention, and actively improve the prognosis, reduce long-term induced Abnormal, the occurrence of disability, and this therapy in clinical practice. Methods: 1. observation group from October 2015 2016 02 months admitted to our hospital for treatment of 174 cases of neonatal hypoxic ischemic encephalopathy in the observation group, all patients were diagnosed according to HIE standard. In the basis of the informed consent of the parents of children further randomly divided into A, B two groups: A group: 88 cases were given to three symptomatic neonatal 3D regular treatment of ganglioside and given 1 courses in the first 1,2,3 months of consolidation, the introduction of comprehensive intervention measures at fourth months (massage, infant exercise, audio-visual stimulation, massage, psychological support, exercise ability stimulation, which, for the weak region for intensive treatment); 86 cases in group B, HIE were the best treatment time window for postpartum 6h, to be in stable condition, on the basis of A, the neonatal period into comprehensive intervention measures; 2. Control group: select the same period in 80 normal children and children's Hospital of Department of health care as the control; 3. strict inclusion and exclusion criteria; 4. observation group and control group were child heart scale determination in 1,2,3,6,9,12 months, and data collection; results: This study showed that the exclusion of participants for various reasons lost and quit, and group B in the neonatal period began intervention compared to A group after comprehensive intervention of developmental quotient scores slightly lower relative to the B group, and in the sixth month development quotient score difference, although compared with the control group intelligence development slightly worse, but the intelligence development trend is similar to that of the control group infants with the increase of age, developmental quotient increased gradually with the general growth of infants, the observation group A group HIE patients after fourth months of intelligence although the index has increased, but the observation group and B group differences in each period and different groups of HIE patients Er Er heart score difference (P0.001), with statistical significance. Conclusion: the child heart scale test in children with developmental quotient, can discover the developmental deviation of children for early clinical intervention, improve the prognosis, and provide scientific basis for reducing the neonatal period of children with disabilities; introduce comprehensive treatment measures, the child heart scale each region can be quantitative evaluation, the weak region targeted intervention treatment can improve the prognosis of neonatal hypoxic ischemic encephalopathy in a certain extent, it is worthy of clinical application.

【学位授予单位】：河南科技大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R742

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