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目的探讨新生儿基底节病变的临床转归。方法在我院康复治疗的新生儿期基底节病变患儿为观察组,按病因分为窒息组,宫内缺氧组和胆红素脑病组,均给予早期综合干预至18个月,患儿分别在6、9、12个月时行头颅MRI检查,6、12、18个月时做智力检查,并与健康新生儿组成的对照组进行比较。结果观察组57例,其中窒息组21例,宫内缺氧组20例,胆红素脑病组16例;对照组20例。观察组各组6个月时,MRI基底节病变恢复比较差异无统计学意义(P>0.05),9、12个月时,窒息组、宫内缺氧组较胆红素脑病组MRI恢复率高(P均<0.05);窒息组、宫内缺氧组脑性瘫痪发生率低于胆红素脑病组(P<0.05),6个月时MRI基底节恢复正常的患儿无脑性瘫痪发生;18个月时,观察组3组大运动、精细动作、适应行为3个能区发育商与对照组差距均缩小,但语言、个人社交2个能区发育商改善不明显。结论新生儿基底节异常信号如6个月未恢复,则提示预后不佳,有出现智力落后及脑性瘫痪可能;新生儿基底节病变可导致认知障碍,目前早期综合干预治疗方法不理想,应引起重视。
Objective To investigate the clinical outcome of neonatal basal ganglia lesions. Methods The neonates with basal ganglia disease in our hospital were divided into the asphyxia group, the intrauterine hypoxia group and the bilirubin encephalopathy group according to their etiology. All patients were given early comprehensive intervention to 18 months. Brain MRI was performed at 6, 9, and 12 months respectively. Intelligence tests were performed at 6, 12, and 18 months and compared with healthy neonates. Results The observation group of 57 cases, of which 21 cases of asphyxia group, intrauterine hypoxia group of 20 cases, bilirubin encephalopathy group of 16 cases; control group of 20 cases. There was no significant difference in the recovery of lesions of the basal ganglia in the observation group at 6 months (P> 0.05). At 9 and 12 months, the recovery rate of MRI in the asphyxia group and intrauterine hypoxia group was significantly lower than that of the bilirubin encephalopathy group (P <0.05). The incidence of cerebral palsy in asphyxia group and intrauterine hypoxia group was lower than that in bilirubin encephalopathy group (P <0.05). No cerebral palsy occurred in children with normal basal ganglia at 6 months At 18 months, the differences between the three development zones of the observation group and the control group were all narrowed. However, there was no obvious improvement in the development of the two energy zones in language and individual social areas. Conclusions Abnormal signal of basal ganglia in neonates did not recover after 6 months, suggesting poor prognosis and possible mental retardation and cerebral palsy. Neonatal basal ganglia lesions may lead to cognitive impairment. At present, the comprehensive early intervention therapy is not ideal, Should pay attention.