目的 回顾性研究高危儿童早期全身运动评估(general movements assessment,GMs)及脑电图(electroencephalogram,EEG) 表现,分析GMs在脑瘫预测中的运用价值以及脑电图在高危儿中的应用价值。方法 研究对象2011年12月31日满1周岁、且于复旦大学附属儿科医院康复中心进行随访的高危儿童,回顾性查找其出生后0~6月内GMs和EEG检查结果,同时具备两项检查的儿童纳入本研究。统计分析GMs对脑瘫的阳性预测值和阴性预测值、特异性和敏感性,不同发育结局儿童中EEG的比较。结果 共纳入62例患儿,28例运动结局为脑瘫,11例为运动发育迟缓,23例为正常。GMs预测脑瘫敏感度96.4%,特异度73.9%,阳性预测值81.8%,阴性预测值94.4%;脑瘫儿童GMs异常率为96.4%,与运动发育迟缓儿童GMs异常率(63.6%)和运动发育正常儿童中GMs异常率(26.1%)差异有统计学意义。脑瘫及运动发育迟缓儿童EEG异常率分别为78.6%、81.8%,两者差异无统计学意义,但均高于运动发育正常儿童中EEG异常率(53.3%)(P<0.05);EEG异常主要表现为尖波、尖慢波发放,高电压及基本活动慢。 结论 GMs能有效地早期预测脑瘫,综合运用GMs、EEG能较全面反应患儿功能状况。
Abstract
Objective To analyze prechtl's qualitative general movements assessment(GMs) and electroencephalogram(EEG) of children with different motor development outcomes retrospectively and investigate the GMs value in predicting of cerebral palsy. Methods The GMs and EEG reports of children more than one-year-old who had been hospitalized in neonatal intensive care unit were collected.The diagnosis of cerebral palsy was made according to the international cerebral palsy diagnostic definition published in 2006.Stata 11.0 was used to analyze GMs positive predictive values,negative predictive values,specificity and sensitivity among different groups and the difference of EEG. Results A total of sixty-two children were enrolled,28 of them were diagnosed as cerebral palsy,11 were motor retardation and 23 were normal.The predictive validity of GMs was as following:sensitivity 96.4%,specificity 73.9%,positive predictive value 81.8% and negative predictive value 94.4%.The rate of abnormal GMs in children of cerebral palsy was significantly higher than that in motor retardation and normal children.The rate of abnormal EEG in children of cerebral palsy and motor retardation were 78.6% and 81.8% respectively,higher than that in normal children(53.3%).The abnormalities of EEG mainly were sharp wave,sharp slow wave,high voltage and slow basic activities. Conclusions GMs assessment could be used in high risk infants within 4 to 5 months to give a reliable and valid prediction for later motor development outcome,especially for cerebral palsy.Application of GMs and EEG would help comprehensive assessment of patients' function status.
关键词
全身运动评估 /
脑电图 /
高危新生儿 /
运动发育结局 /
脑性瘫痪
Key words
prechtl's qualitative general movements assessment /
electroencephalogram /
high risk infant /
motor development outcome /
cerebral palsy
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参考文献
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