口服布美他尼联合康复训练治疗儿童孤独症的初步研究

发布时间：2019-03-06 16:19

【摘要】：目的：观察康复训练联合布美他尼治疗对新诊断的孤独症患儿社会交往、言语及非言语交流、兴趣行为的影响，为儿童孤独症的治疗寻求新的治疗方法。方法：收集吉林大学白求恩第一医院小儿神经康复科自2010年10月至2011年12月收治的96例新诊断的孤独症患儿的病例资料。根据患儿家长的意愿分为三组:布美他尼治疗组26例，康复训练治疗组32例，康复训练联合布美他尼治疗组38例。康复训练项目主要有人际关系发展干预、图片交换交流系统、作业治疗、言语治疗、孤独症以及相关障碍儿童治疗教育课程、应用行为分析疗法、丹佛模式，患儿每天接受3-4种训练项目，1次30-45分钟；布美他尼：3岁以内患儿0.3mg/次，日2次口服，3岁以上患儿0.5mg/次，日2次口服，，最高不超过2mg/天。三组于治疗前及治疗后1个月、2个月、3个月、6个月分别行ABC、CARS、CGI评估；对BUM组及RT+BUM组分别于开始治疗前及服用布美他尼后1个月、2个月、3个月、6个月复诊进行血常规、尿常规、肝功、心肌酶、肾功、血离子、血糖及心电图评估。结果：（1）三组一般特征资料比较：三组年龄、起病年龄、病程、居住地、抚养人、母孕年龄、父育年龄、阳性家族史、胎次、分娩类型、出生体重、出生窒息史、爬行史、语言发育史组间比较差异均无统计学意义。（2）治疗前后ABC评分比较：治疗后三组ABC总分及单项分与治疗前比较均有降低。治疗后6个月ABC总分与治疗前比较，三组治疗前后差异均有统计学意义，其中，RT+BUM组ABC总分及单项分降低最明显，其次为RT组，最后为BUM组，三组ABC总分组间差异两两比较均有统计学意义。（3）治疗前后CARS评分比较：治疗后三组CARS总分及单项分与治疗前比较均有降低。治疗后6个月CARS总分与治疗前比较，三组治疗前后差异均有统计学意义，其中，RT+BUM组CARS总分及单项分降低最明显，其次为RT组，最后为BUM组，BUM与RT+BUM组总分差异有统计学意义。（4）治疗前后CGI评分比较：与治疗前比较，治疗后三组SI均有降低。治疗后6个月SI与治疗前比较，三组治疗前后差异均有统计学意义，其中，RT+BUM组SI、GI降低、EI提高最明显，其次为RT组，最后为BUM组，BUM组与RT+BUM组SI、GI、EI评分差异均有统计学意义。（5）治疗后保留率比较：治疗后6个月BUM组的保留率为84.6%（22/26例）；RT组的保留率为87.5%(28/32例)；RT+BUM组的保留率为86.8%（33/38例）。三组治疗后6个月保留率比较无统计学意义。（6）副作用观察：三组6个月治疗随访过程中，BUM组及RT+BUM组血常规、尿常规、肝功、心肌酶、肾功、血离子、血糖、心电图均未发现异常。结论：（1）布美他尼可减少孤独症儿童孤独症样行为，而且没有明显的副作用。（2）康复训练联合布美他尼治疗儿童孤独症效果优于单纯康复训练治疗。
[Abstract]:Aim: to observe the effects of rehabilitation training combined with bumetanil on social communication, verbal and nonverbal communication, and behavior of interest in newly diagnosed autistic children, so as to find a new treatment for children with autism. Methods: the data of 96 newly diagnosed autistic children in the Department of Pediatric Neurorehabilitation, Bethune first Hospital, Jilin University from October 2010 to December 2011 were collected. According to the parents' wishes, they were divided into three groups: bumetanil treatment group (26 cases), rehabilitation training group (32 cases) and rehabilitation training combined with bumetanil treatment group (38 cases). Rehabilitation training programs include interpersonal relationship development interventions, picture exchange communication systems, job therapy, speech therapy, autism and related disorder treatment education courses for children, applied behavioral analysis therapy, Denver model, The children received 4 kinds of training items every day for 30 minutes and 45 minutes at a time. Bumetanil: 0.3mg/ twice a day in children under 3 years old, 0.5mg/ twice a day in children over 3 years old, and no more than 2 times a day in children over 3 years old. The highest dose was no more than 2mg/ days. Three groups were evaluated by ABC,CARS,CGI before treatment and 1 month, 2 months, 3 months and 6 months after treatment. Blood routine, urine routine, liver function, myocardial enzyme, renal function, blood ion, blood glucose and electrocardiogram were evaluated before and 1 month, 2 months, 3 months and 6 months after the treatment of bumetanil in BUM group and RT BUM group, respectively. The blood routine, urine routine, liver function, myocardial enzyme, renal function, blood ion, blood sugar and ECG were evaluated. Results: (1) the data of three groups were compared: age, onset age, course of disease, place of residence, caregiver, pregnant age, paternity age, positive family history, number of births, birth type, birth weight, birth asphyxia history. There was no significant difference in reptile history and language development history between groups. (2) comparison of ABC scores before and after treatment: after treatment, the total score and single score of ABC in the three groups were lower than those before treatment. Six months after treatment, the total scores of ABC in the three groups were significantly lower than those before and after treatment. The total score and single score of ABC in the, RT BUM group decreased most significantly, followed by the RT group, and the last group was the BUM group. The difference among the three groups of ABC was statistically significant. (3) comparison of CARS scores before and after treatment: after treatment, the total score and single score of CARS in the three groups were lower than those before treatment. Six months after treatment, the total scores of CARS in the three groups were significantly lower than those before and after treatment. The total score and single score of CARS in the, RT BUM group decreased most significantly, followed by the RT group, and the last group was the BUM group. There was a significant difference in the total score between BUM and RT BUM group. (4) comparison of CGI scores before and after treatment: compared with pre-treatment, the SI of three groups decreased after treatment. 6 months after treatment, there were significant differences in SI between the three groups before and after treatment. SI,GI in, RT BUM group was decreased and EI was increased most obviously, followed by RT group, BUM group and RT BUM group SI,GI,. The difference of EI score was statistically significant. (5) comparison of retention rate after treatment: the retention rate in BUM group was 84.6% at 6 months after treatment (87.5% in 22 cases of); RT group and 86.8% in 32 cases of); RT BUM group in 28 cases). There was no significant difference in retention rate at 6 months after treatment among the three groups. (6) side effects observation: during the 6-month follow-up of three groups, no abnormality was found in blood routine, urine routine, liver function, myocardial enzyme, kidney function, blood ion, blood sugar and ECG in BUM group and RT BUM group. Conclusion: (1) bumetanil can reduce autism-like behavior in autistic children without obvious side effects. (2) the effect of rehabilitation training combined with bumetanil in the treatment of childhood autism was better than that of rehabilitation training alone.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R749.94

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