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目的:探讨联合干预措施对早产儿脑白质损伤(WMD)的防治和远期预后的影响。方法:以2003年1月~2005年6月因各种疾病在本院住院并确诊存在脑白质损伤的早产儿64例为研究对象,随机分为干预组、对照组各32例。干预组采用神经节苷脂、早期干预、康复训练治疗;对照组采用常规育儿方式,所有患儿定期来院随访。纠正胎龄40周时行NBNA评分1次,3、6、12个月各进行1次CDCC智力测验,18个月时进行1次Gesell智力测验。结果:1个月时脑室周围白质软化(PVL)发生率及6个月时头颅B超异常率两组比较,差异有显著性(P<0.05);纠正胎龄40周时NBNA评分两组相比,差异无显著性(P>0.05);3个月时智能发育指数(MD I)和运动发育指数(PD I)两组比较,差异无显著性(P>0.05);6、12个月时两组相比,差异有显著性(P<0.05),Gesell智力发育检查,发现干预组在适应性、大运动、精细运动、语言和社会交往5个能区与对照组相比,差异有显著性(P<0.05)。两组发生脑瘫和精神发育迟滞的例数分别为5例、14例和1例、3例。结论:对早产儿脑白质损伤患儿采用联合干预措施能显著减少脑瘫、智能发育迟滞等后遗症的发生,改善其预后。
Objective: To investigate the effect of combined intervention on the prevention and treatment of long-term prognosis of white matter damage (WMD) in preterm infants. Methods: From January 2003 to June 2005, 64 cases of premature infants who were hospitalized with various diseases in our hospital and were diagnosed as having white matter damage were randomly divided into intervention group and control group with 32 cases each. The intervention group was treated with gangliosides, early intervention and rehabilitation training. In the control group, routine child-care method was adopted, and all children were followed up regularly. Correct gestational age 40 weeks NBNA score 1, 3, 6, 12 months for each CDCC intelligence tests, 18 months, a Gesell intelligence test. Results: The incidence of periventricular leukomalacia (PVL) at 1 month was significantly higher than that at 6 months (P <0.05). Correlation of NBNA score at two weeks (P> 0.05). There was no significant difference in MDI and PDI between the two groups at 3 months (P> 0.05), but no significant difference between 6 and 12 months There was significant difference between the two groups (P <0.05), Gesell mental development examination, found that the intervention group in adaptation, big exercise, fine motor, language and social interaction in the five energy zones compared with the control group, the difference was Significance (P <0.05). Two cases of cerebral palsy and mental retardation cases were 5 cases, 14 cases and 1 case, 3 cases. Conclusion: The joint intervention of children with white matter damage in preterm infants can significantly reduce the occurrence of sequelae, such as cerebral palsy and delayed mental retardation, and improve their prognosis.