全身运动质量结合诱发电位在预测高危新生儿运动发育中的应用

摘要

Objective To explore the clinical value of early application of general movements (GMs) combined with evoked potentials (EPs) in predicting motor development of high-risk neonates. Methods A total of 112 high-risk neonates in fol-low-up clinic of pediatric neurological rehabilitation were selected. GMs evaluation and EPs detection were measured in writhing movements period and ifdgety movements period respectively. The motor developmental outcomes were determined at the cor-rected age of 12 months after continuous follow-up according to the diagnostic criteria (2006) of cerebral palsy (CP) and Peabody motor development scale. The predictive validity of GMs, EPs and the combination of GMs and EPs was calculated. Results The motor developmental outcomes of 112 cases showed that there were 26 cases (23.2%) of CP, 14 cases (12.5%) of motor retar-dation and 72 normal cases (64.3%). In writhing movements period, the predictive validity of GMs in conjunction with median nerve somatosensory evoked potentials (MNSEP) for abnormal motor development was as follows:sensitivity 80%, speciifcity 98.6%, positive predictive value 97%, and negative predictive value 89.9%. In ifdgety movements period, the predictive validity of GMs for CP was as follows:sensitivity 96.1%, speciifcity 97.7%, positive predictive value 92.6%and negative predictive value 98.8%. However, the predictive validity of the combination of GMs and MNSEP for CP had no signiifcant increase. The predictive validity of MNSEP in both writhing movements period and ifdgety movements period for abnormal motor develop-ment was as follows:sensitivity 82.5%, speciifcity 91.7%, positive predictive value 84.6%and negative predictive value 90.4%. Conclusions In writhing movements period, combination with GMs and MNSEPs can improve the predictive validity for ab-normal motor development in high-risk neonates.%目的：探讨早期应用全身运动(GMs)质量评估技术结合诱发电位(EPs)对预测高危新生儿运动发育的临床价值。方法选择112例儿童神经康复科门诊随访的高危新生儿，分别在GMs扭动运动阶段和不安运动阶段进行GMs评估和EPs检测，连续随访并在纠正年龄12月龄时根据2006年脑瘫(CP)诊断标准及Peabody运动发育量表确定其运动发育结局，计算全身运动质量、诱发电位以及两者结合的预测效度。结果112例研究对象运动发育结局，脑瘫26例(23.2%)、运动发育迟缓14例(12.5%)、正常72例(64.3%)。扭动运动阶段GMs及正中神经诱发电位(MNSEP)均异常对运动发育异常的预测灵敏度80.0%，特异度98.6%，阳性预测值97.0%，阴性预测值89.9%；不安运动阶段GMs异常对于脑瘫的预测灵敏度96.1%，特异度97.7%，阳性预测值92.6%，阴性预测值98.8%；GMs及MNSEP均异常预测效度无显著提高。两阶段中MNSEP均异常对运动发育异常的预测灵敏度82.5%，特异度91.7%，阳性预测值84.6%，阴性预测值90.4%。结论在扭动运动阶段联合GMs及MNSEP可提高对高危新生儿运动发育异常的预测效度。