目的 分析早产儿轻度运动发育迟缓的评定及早期干预模式,为早产儿随访及干预提供新模式。方法 选取2018年3月1日-2019年3月31日在南方医科大学附属小榄医院儿童保健科建卡并常规随访的早产儿100例。研究对象用0~1岁20项神经运动检查(20项)检查,并被分为干预组33例、对照组31例、正常组32例及转诊的早产儿4例。比较干预组与对照组早产儿干预后的Alberta婴儿运动量表(AIMS)得分及12月龄时3组早产儿发育商(DQ)。结果 1)干预后,干预组AIMS得分高于对照组,差异有统计学意义(t=2.06,P<0.05)。2)干预组、正常组与对照组12月龄时的大运动DQ、言语DQ、社交行为DQ比较,差异有统计学意义(F=9.49、9.02、4.53,P<0.05)。两两比较结果显示,对照组与正常组、对照组与干预组间的大运动DQ差异均有统计学意义(P<0.05);干预组与正常组、对照组与正常组间的言语DQ比较,差异均有统计学意义(P<0.05);对照组与正常组间的社交行为DQ比较,差异有统计学意义(P<0.05);其余组间两两比较差异无统计学意义(P>0.05)。3)转诊早产儿4例,无视、听异常婴儿。结论 以20项为随访基础、以AIMS为早期干预指导基础及以Bobath运动疗法为主的早期综合干预模式在轻度运动发育迟缓早产儿随访中具有可行性。
Abstract
Objective To analyze the assessment and early intervention mode of mild motor developmental delay in preterm infants,in order to provide a new mode for follow-up and intervention of preterm infants. Methods A total of 100 preterm infants with first follow-up card and routine follow-up from March 1st,2018 to March 31st,2019 in the Children′s Health Department of Affiliated Xiaolan Hospital,Southern Medical University were selected in this study,and were examined by 20 neuromotor examinations at 0-1 years (20-items).The preterm infants were divided into intervention group (n=33),control group (n=31) and normal group (n=32),and 4 cases of premature infants were referred.The Alberta Infant Motor Scale (AIMS) scores of the preterm infants in intervention group and control group were compared after intervention and the development quotient (DQ) of the three groups of preterm infants at the age of 12 months were compared. Results 1) After the intervention,AIMS score of the intervention group was significantly higher than that of the control group (t=2.06,P<0.05).2) The gross motor DQ,verbal DQ,and social behavior DQ at 12 months old among the intervention group,normal group and control group were significantly different (F=9.49,9.02,4.53,P<0.05).Further analysis showed that the difference on gross motor DQ between control group and normal group,as well as between control group and intervention group were both significant (P<0.05).Differences on verbal DQ between intervention group and normal group,as well as between control group and normal group were significant (P<0.05).Moreover,the difference on social behavior DQ between control group and normal group was significant (P<0.05),but there was no statistically significant difference between the other groups (P>0.05).3) Four cases of premature infants were referred and there were no infants with visual or hearing abnormalities. Conclusion The early comprehensive intervention mode based on 20 neuromotor examinations for follow-up,AIMS as the guidance for early intervention and the early interventions focused on Bobath therapy is feasible in the follow-up of premature infants with mild motor retardation.
关键词
运动发育迟缓 /
早产儿 /
20项神经运动检查 /
Alberta婴儿运动量表
Key words
motor development retardation /
preterm infants /
20 neuromotor examinations /
Alberta Infant Motor Scale
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] 侯新琳,周丛乐.早产儿的脑发育问题及其检查与评价[J].中华围产医学杂志,2005,8(1):60-62.
[2] 林洁,陈超.出生后感染/炎症与早产儿脑病相关性研究进展[J].中华医学杂志,2016,96(22):1795-1800.
[3] 朱志成,陈超.超早产儿运动功能远期预后的研究进展[J].中华儿科杂志,2019,57(4):301-304.
[4] Kilbride HW,Aylward GP,Doyle LW,et al.Prognostic neurodevelopmental testing of preterm infants:do we need to change the paradigm[J].J Perinatol,2017,37(5):475-479.
[5] 唐久来,李宝田,李晓捷.脑性瘫痪早期诊断和脑性瘫痪高风险儿诊断及早期干预进展[J].中华实用儿科临床杂志,2018,33(15):1121-1125.
[6] 罗蓉,母得志.建立早产儿脑损伤的随访与早期干预体系[J].四川大学学报:医学版,2013,44(2):265-269.
[7] 国家卫生和计划生育委员会办公厅.早产儿保健工作规范[J].中华围产医学杂志,2017,20(6):401-406.
[8] 鲍秀兰.0~3岁儿童最佳的人生开端-中国宝宝早期教育与潜能开发指南[M].北京:中国发展出版社,2006:237-267,343-357.
[9] Martha CP,Darrah J.发育中婴儿的运动评估-Alberta婴儿运动量表[M].黄真,李明,译.北京:北京大学医学出版社,2009:11-17,27-38.
[10] 杨玉凤,金星明,静进,等.发育行为儿科手册[M].南京:江苏科学技术出版社,2009:438-457.
[11] 陈秀洁.小儿脑性瘫痪的神经发育学治疗法[M].郑州:河南科学技术出版社,2012,28:237-289.
[12] 杨善浦,吴月超,刘红艳.0~6月龄脑损伤高危儿20项神经运动筛查与干预效果评估[J].中国乡村医药,2016,23(15):21-22.
[13] 王茂彬.神经康复学[M].北京:人民卫生出版社,2009:688.
[14] Campos D,Santos DC,Goncalves VM,et al.Agreement between scales for screening and diagnosis of motor development at 6 months[J].J Pediatr(Rio J),2006,82(6):470-474.
[15] Gosselin J,Gahagan S,Amiel-Tison C.The Amiel-Tison Ne urological Assessment at Term:conceptual and methodological continuity in the course of follow-up[J].Ment Retard Dev Disabil Res Rev,2005,11(1):34-51.
[16] 王翠,黄真.A1berta婴儿运动量表[J].中国康复医学杂志,2009,24(9):858-861.
[17] 张怡文,郭津.高危儿早期干预的理论基础及干预策略的研究进展[J].中国康复,2019,34(2):101-104.
[18] 梁玉琼,李晓捷,陈美慧.《国际功能、残疾和健康分类(儿童和青少年版)》在儿童康复中的应用[J].中国康复医学杂志,2019,34(2):224-228.
[19] 王美绮.家长育儿知识水平对婴幼儿健康影响的研究[J].昆明医学院学报,2006,27(4):68-71.
[20] 许琪,李瑞莉,尹德卢,等.不同省市0~6岁儿童主要看护人育儿知识和行为情况调查及影响因素分析[J].中国妇幼保健,2015,30(8):1222-1225.
[21] Serenius F,Ewald U,Farooqi A,et al.Neurodevelopmental outcomes among extremely preterm infants 6.5 years after active perinatal care in Sweden[J].JAMA Pediatr,2016,170(10):954-963.
[22] De Groote I,Vanhaesebrouck P,Bruneel E,et al.Outcome at 3 years of age in a population_based cohort of extremely preterm infants[J].Obstet Gynecol,2007,110(4):855-864.
基金
中山市医学科研项目(2018A020279)