目的 通过分析早产儿24个月龄Gesell量表结果,研究早产儿生后24个月龄的神经心理发育情况,为改善早产儿的神经心理发育结局提供依据。方法 选取钦州市妇幼保健医院新生儿科住院且出院后定期随访、资料完整的早产儿为早产儿组(n=278),根据出生胎龄(GA)将早产儿分为GA＜32周组(n=102)和GA≥32周组(n=176);抽取同期健康足月儿为足月儿组(n=113);收集所有研究对象24月龄Gesell量表发育商(DQ);比较早产儿组与足月儿组、早产儿各组与足月儿组Gesell量表结果;了解不同出生胎龄早产儿在生后24月龄神经心理发育的差异。结果 各组生后24月龄Gesell量表结果:1)早产儿组大运动、精细运动异常发生率及其DQ值与足月儿相比,差异均无统计学意义(P>0.05);但语言、个人社交和适应性异常的发生率较足月儿高,相对应的DQ值较足月儿低。2)GA≥32周的早产儿大运动、精细运动、语言、个人社交、适应性的异常发生率分别与足月儿相比,差异均无统计学意义;但语言、个人社交和适应性的DQ值仍低于足月儿。3)GA＜32周的早产儿大运动、精细运动、语言、个人社交、适应性异常发生率均显著高于足月儿,相对应的DQ值均低于足月儿。结论 大多数早产儿,生后24个月龄的大运动、精细运动已达到足月儿水平,但语言、个人社交和适应性的发育仍落后于足月儿;GA＜32周的早产儿神经心理发育未达到足月儿水平,仍需延长随访和加强干预。

Objective To explore the neuropsychological development of 24-month-old preterm infants by analysing the results of Gesell Developmental Scale,and to provide evidence for improving neuropsychological development of preterm infants. Methods A total of 278 preterm infants admitted to the Neonatology Department of Qinzhou Maternal and Child Health Care Hospital and regularly followed up after discharge were selected as the preterm group,and were divided into two subgroups according to gestational age (GA).A total of 113 full-term infants admitted during the same period were selected as the term group.Gesell developmental quotients (DQs) of all infants at their 24 months old were collected and the results of Gesell Developmental Scale were compared among all the groups to find out the differences in their neuropsychological development. Results 1) There was no significant difference on the incidences of abnormal gross motor movement and abnormal fine movement between preterm group and term group (P>0.05).No significant difference had been found in the DQs of those functional areas between the two groups.Compared with the term group,the preterm group had higher incidences of abnormality in language,adaptability and social contact,and lower DQs of those functional areas.2) There was no significant difference in the incidence of abnormality in gross motor movement,fine motor movement,language,adaptability and social contact between preterm infants with GA≥32 weeks and term infants.However,the DQs of the three functional areas(language,adaptability and social contact) were lower in preterm infants with GA≥32 weeks.3) Compared with term infants,preterm infants with GA less than 32 weeks had higher incidences of abnormality in all functional areas and lower DQs of all functional areas. Conclusions The majority of 24-month-old preterm infants have catched up with the term infants in gross motor movement and fine movement,however,the development of language,adaptability and social contact is still delayed.The neuropsychological development of preterm infants with GA less than 32 weeks is not balanced with that of term infants.Therefore,it is necessary to extend the length of follow-up time and strengthen the intervention.