不安运动缺乏早期预测脑性瘫痪的临床研究

发布时间：2018-12-12 11:42

【摘要】：目的：探索不安运动缺乏早期预测脑性瘫痪的预测效度及正常不安运动伴随异常运动序列时对运动发育落后的预测意义。方法：研究对象为2012年6月至2013年3月就诊于我院小儿神经康复科的神经发育高危儿，记录其不安运动阶段的全身运动并进行质量评估，在首次评估间隔1个月后对研究对象进行第二次评估，测定重测信度。全身运动质量评估的结果以第二次评估为准，研究对象随访至12个月以上，明确运动发育结局，通过计算评估的敏感性、特异性、阳性预测值和阴性预测值，探索不安运动缺乏对脑性瘫痪的预测效度；并将存在正常不安运动的研究对象按是否伴随异常运动序列分为两组，通过比较两组研究对象的独走月龄，探索不安运动伴随异常运动序列对运动发育落后的预测意义。结果：本研究共纳入51例研究对象，男32例，女19例，孕龄27～42周，，平均孕龄37.0±3.3周，出生体重1300～4500g，平均出生体重3060.9±780.2g。不安运动记录时间为矫正胎龄后9～20周，平均13.5±2.8周。两次评估结果的重测一致性为κ=0.60，P＜0.01。51例研究对象中，35例（68.6%）存在正常不安运动,15例（29.4%）不安运动缺乏,1例（2.0%）存在异常不安运动。不安运动缺乏者中14例（93.3%）运动发育结局为脑性瘫痪，不安运动缺乏对脑性瘫痪的预测敏感性为93.7%，特异性为97.1%，阳性预测值为93.8%，阴性预测值重测为97.1%。全身运动质量评估结果为不安运动存在的研究对象中，不伴随异常运动序列的16例研究对象独立行走月龄为11～14月，平均12.2±0.9月，伴随异常运动序列的19研究对象独立行走月龄为11～16月，平均13.8±1.4月，两组独立行走月龄的差异有统计学意义（t=4.153，P＜0.01）。结论： ⑴不安运动缺乏对脑性瘫痪具有良好的预测效度。 ⑵不安运动伴随异常运动序列对预测运动发育落后具有一定价值。
[Abstract]:Objective: to explore the predictive validity of early prediction of cerebral palsy due to the lack of restless movement and the predictive significance of abnormal motion sequence in patients with normal restless movement. Methods: from June 2012 to March 2013, the subjects of the study were children with high risk of nerve development who were admitted to the Department of Neurorehabilitation of our hospital from June 2012 to March 2013. A second assessment was conducted after the first assessment interval of 1 month to determine retest reliability. The results of the general exercise quality assessment were based on the second evaluation. The subjects were followed up to more than 12 months to determine the outcome of motor development. The sensitivity, specificity, positive predictive value and negative predictive value of the evaluation were calculated. To explore the lack of predictive validity of restless motion for cerebral palsy; The subjects with normal unsteady motion were divided into two groups according to whether or not they were accompanied by abnormal motion sequence. By comparing the age of the two groups, the predictive significance of the sequence of abnormal motion accompanied by uneasiness motion for the development of backward movement was explored. Results: a total of 51 subjects were included in the study, including 32 males and 19 females. The gestational age was 2742 weeks, the average gestational age was 37.0 卤3.3 weeks, and the average birth weight was 1 300 卤4 500 g, with an average birth weight of 3060.9 卤780.2 g. The recording time of restless motion was 9 ~ 20 weeks (mean 13.5 卤2.8 weeks) after corrected gestational age. The retest consistency of the two evaluation results was 魏 = 0.60 (P < 0.01.51), 35 cases (68.6%) had normal restless movement, 15 cases (29.4%) were lack of restless movement. One case (2.0%) had abnormal movement. 14 (93.3%) of the patients with restless motor deficiency had cerebral palsy. The predictive sensitivity, specificity and positive predictive value of restless motor deficiency for cerebral palsy were 93.7g, 97.1g, 93.8g, 93.3%, 93.3%, 93.3%, 93.3%, 93.3%, 93.3%, 93.3%, 93.3% respectively. The negative predictive value was 97. 1%. Among the subjects whose body motion quality evaluation results were restless motion, 16 subjects who were not accompanied by abnormal motion sequence walked independently for 11 to 14 months with an average age of 12.2 卤0.9 months. The age of independent walking was 11 ~ 16 months (mean 13.8 卤1.4 months) in 19 subjects with abnormal motion sequence. The difference between the two groups was statistically significant (t = 4.153, P < 0.01). Conclusion: 1 lack of restless movement has good predictive validity for cerebral palsy. 2 uneasiness motion accompanied by abnormal motion sequence has certain value in predicting motor developmental backwardness.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R742.3

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