早期干预对缺氧缺血性脑病患儿智能和心理运动发育的影响

摘要

BACKGROUND: Perinatal hypoxic-ischemic encephalopathy(HIE) is the primary cause of neonatal brain injury, which retards the mental development in affected infants.OBJECTIVE: To investigate the influence of early intervention on mental and psychological development in infants with HIE, study the time-effect relation of the early intervention, and to find an optimal time for intervention.DESIGN: A time series of following-up and a non-randomized concurrent controlled investigation.SETTING: Xiangya Hospital and Xiangya School of Medicine Affiliated to Central South University.PARTICIPANTS: From February 1999 to May 2001, in the Pediatric Department of Xiangya Hospital Affiliated to the Central South University, the inpatient and outpatient infants with HIE were selected. There were 32 inpatients in the intervention group, 10 with moderate HIE and 22 with severe HIE. There were 36 outpatients in the control group, 10 with moderate HIE and 26 with severe HIE. Comparison was performed between these two groups.METHODS: BRS and the Infant and Child Mental Development Scales,made by The Institute of Psychology of The Chinese Academy of Science and The China National Children' s Center(CNCC), were adopted in the assessment between the two groups.MAIN OUTCOME MEASURES: Mental Development Index(MDI) and Psychomotor Development Index(PDI) scores of the two groups were compared.were significantly higher in the intervention group(90.50 ± 11.12/90. 34±12.49,94.06±14.96/92.03±13.07,90.78±7.46/91.38 ± 13.87)than those in the control group(62.28±7.44/62.67±6.06, 59.11following-up results showed that one patient in the intervention group had a MDI score at the critical threshold value, and two patients had PDI scores at the critical threshold value. For all the other patients in this group, the MDI/PDI scores of them were above the moderate range. In contrast, all the 36 infants in control group had developed mental deficiencies at that time.CONCLUSION: A quantifiable effect of the intervention can be observed in patients at 3 months of life. This indicates that an early intervention is essential for improving the mental development in infants with HIE.%背景:围产期缺血缺氧性脑病易导致脑损伤,对患儿智能发育产生影响.目的:观察早期干预对缺氧缺血性脑病患儿智能和心理运动发育的影响,研究早期干预的时间和效果的关系,从而找到最佳干预时机.设计:非随机化同期对照,不同时相点随访.单位:中南大学湘雅医院及湘雅医学院.对象:选择1999-01/2001-05中南大学湘雅医院新生儿科诊治的进行早期干预缺氧缺血性脑病患儿(干预组n=32,中度10例,重度22例),与未行早期干预而在门诊确诊的缺氧缺血性脑病患儿(对照组n=36,中度10例,重度26例)作比较.方法:采用新生儿行为神经测定,中国科学院心理研究所和中国儿童发展中心共同编制的婴幼儿智能发育量表分别对两组的患儿进行测定评估.主要观察指标:两组患儿智能发育指数、心理运动发育指数比较.结果:①智能发育指数/心理运动发育指数3,6,18个月时干预组(90.50±11.12/90.34±12.49,94.06±14.96/92.03±13.07,90.78±7.46/91.38±13.87)比对照组明显增高(62.28±7.44/62.67±6.06,59.11±4.74/58.19±4.92,58.83±6.44/58.17±5.33,P＜0.01).②随访结果显示,干预组智能发育指数在临界水平者1例,心理运动发育指数在临界水平者2例,其余患儿智能发育指数和心理运动发育指数检测结果均在中等范围以上;对照组36例患儿均为智能缺陷患儿.结论:干预在3个月时就出现量化效果,说明早期干预对促进缺氧缺血性脑病的患儿智能发育具有重要意义.