【目的】 研究全身运动质量评估(general movements assessment, GMs)及脑干听觉诱发电位(brainstem auditory evoked potential, BAEP)在脑瘫预测中的运用价值。 【方法】 按照纳入和排除标准选择在本院新生儿重症监护室住院,出院后在新生儿科和康复中心进行随访的高危新生儿为研究对象。每例记录GMs,并行BAEP检查,根据2005年发布的国际脑瘫诊断定义至少在1周岁以上时在临床上进行脑瘫的诊断,作为严重异常的神经学发育结局。统计分析各方法对脑瘫的阳性预测值和阴性预测值、特异性和敏感性。 【结果】 共随访27名高危新生儿,其中8例运动结局为脑瘫。GMs预测脑瘫敏感度87.5％,特异度84.2％,阳性预测值70.0％,阴性预测值94.1％;BAEP预测脑瘫敏感度75.0％,特异度36.8％,阳性预测值33.3％,阴性预测值77.7％,BAEP异常主要表现为听阈增高及潜伏期延长。 【结论】 GMs对后期神经发育结局能作出准确有效的预测,尤其对于脑瘫的预测价值相当高,综合运用GMs、BAEP能较全面反应患儿功能状况。
Abstract
【Objective】 Investigate the applying value of prechtl's qualitative general movements assessment(GMs) and brainstem auditory evoked potential(BAEP) in predicting of cerebral palsy. 【Methods】 According to the inclusion and exclusion criterias, infants who took part in our follow-up clinic after discharged from our neonatal intensive care unit were confirmed as the participants. Each infant had GMs and BAEP examination. The follow up lasted for at least one year to identify neurological outcome. The diagnosis of cerebral palsy was made according to the international cerebral palsy diagnostic definition published in 2005. Use SPSS 13.0 to analysis two examination's positive predictive values, negative predictive values, specificity and sensitivity. 【Results】 Twenty-seven high risk infants were followed up, eight of them were diagnosed as cerebral palsy. The predictive validity of GMs was as following: sensitivity 87.5%, specificity 84.2%, positive predictive value 70.0% and negative predictive value 94.1%. The predictive validity of BAEP was as following: sensitivity75.0%, specificity36.8%, positive predictive value 33.3% and negative predictive value 77.7%. The abnormalities of BAEP mainly were elevating of auditory threshold and prolonged latency. 【Conclusions】 GMs assessment can be used in high risk infants within 4 to 5 months to give a reliable and valid prediction for later neurological outcome, especially for cerebral palsy. Comprehensive application of GMs and BAEP can relatively overall impression of infants' function status.
关键词
全身运动评估 /
脑干听觉诱发电位 /
高危新生儿 /
发育结局 /
脑性瘫痪
Key words
prechtl's qualitative general movements assessment /
brainstem auditory evoked potential /
high risk infant /
neurological outcome /
cerebral palsy
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参考文献
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