本文選題：兒心量表　切入點(diǎn)：新生兒缺氧缺血性腦病　出處：《河南科技大學(xué)》2017年碩士論文

【摘要】：目的:新生兒缺氧缺血性腦病患兒早期干預(yù)并非簡(jiǎn)單的藥物治療,其康復(fù)耗費(fèi)時(shí)間長(zhǎng)、手段較多、花費(fèi)大,尋求一種簡(jiǎn)便易行的便于家長(zhǎng)掌握的綜合康復(fù)手段應(yīng)用于臨床顯得非常重要。應(yīng)用兒心量表觀察綜合手段介入的不同時(shí)間窗檢測(cè)患兒的發(fā)育商并進(jìn)行分析、研判,以期尋求更有效的綜合干預(yù)手段及介入時(shí)間窗改善新生兒缺氧缺血性腦病患兒遠(yuǎn)期預(yù)后,有望降低致殘、致畸等后遺癥出現(xiàn)的可能性。重要性:新生兒缺氧缺血性腦病是世界上各國(guó)新生兒時(shí)期發(fā)病率很高的神經(jīng)系統(tǒng)疾病,患兒病情進(jìn)展快、死亡率高,是新生兒致傷、殘的原因之一。有大量研究表明,國(guó)內(nèi)外對(duì)新生兒缺氧缺血性腦病的共識(shí)不一致,有研究者進(jìn)行大量研究認(rèn)為應(yīng)該從臨床癥狀、腦組織形態(tài)學(xué)、腦功能改變、實(shí)驗(yàn)室、影像學(xué)等進(jìn)行綜合判斷,此為臨床醫(yī)師普遍評(píng)估預(yù)后的方法。另有其他研究顯示上述綜合判斷對(duì)新生兒HIE預(yù)后的敏感性高,但特異性較低。為了進(jìn)一步早期、客觀評(píng)估HIE患兒的預(yù)后(包括大運(yùn)動(dòng)、精細(xì)動(dòng)作、語(yǔ)言、社交能力、適應(yīng)能力等),應(yīng)用兒心量表對(duì)患兒腦損傷引起大運(yùn)動(dòng)、精細(xì)動(dòng)作、語(yǔ)言等各方面進(jìn)行量化監(jiān)測(cè),引入綜合治療措施后在不同月齡進(jìn)行再評(píng)估,即將兒心量表作為監(jiān)測(cè)及康復(fù)評(píng)價(jià)的工具,以期尋找一種便于臨床醫(yī)師及家長(zhǎng)共同掌握的干預(yù)手段,積極改善預(yù)后,降低遠(yuǎn)期致畸、致殘率的發(fā)生,并將此治療手段在臨床上推廣使用。方法:1.觀察組:選取2015年10月2016年02月收住我院兒科住院治療的174例新生兒缺氧缺血性腦病患兒為觀察組,所有患兒均符合HIE診斷標(biāo)準(zhǔn)。在家長(zhǎng)知情同意的基礎(chǔ)上將患兒進(jìn)一步隨機(jī)分為A、B兩組:A組88例:給予新生兒期三維持三對(duì)癥正規(guī)治療,并在第1、2、3個(gè)月給予1個(gè)療程的神經(jīng)節(jié)苷酯鞏固,在第4個(gè)月時(shí)引入綜合干預(yù)措施(撫觸、嬰兒操、視聽(tīng)覺(jué)刺激、手法按摩、心理支持、運(yùn)動(dòng)能力刺激等,其中,對(duì)于薄弱能區(qū)進(jìn)行針對(duì)性強(qiáng)化治療);B組86例,因HIE患兒最佳治療時(shí)間窗為產(chǎn)后6h,待病情平穩(wěn)后,在A組的基礎(chǔ)上,新生兒期引入綜合干預(yù)措施;2.對(duì)照組:選擇同期在醫(yī)院兒童保健科就診的80例正常兒童作為對(duì)照;3.嚴(yán)格制定納入和排除標(biāo)準(zhǔn);4.觀察組和對(duì)照組在1、2、3、6、9、12個(gè)月時(shí)進(jìn)行兒心量表測(cè)定,并進(jìn)行數(shù)據(jù)收集;結(jié)果:本研究顯示,排除因各種原因失訪和中途退出的研究對(duì)象,與B組在新生兒期即開(kāi)始干預(yù)相比,給予A組綜合干預(yù)措施后的發(fā)育商分值相對(duì)B組稍低,且在第6個(gè)月時(shí)發(fā)育商分值差別較大,雖與對(duì)照組相比智能發(fā)育略差,但智能發(fā)育趨勢(shì)相似,對(duì)照組嬰兒隨著年齡的增長(zhǎng),發(fā)育商逐漸增加,符合嬰幼兒一般生長(zhǎng)規(guī)律,觀察組A組HIE患兒在第4個(gè)月之后智能指數(shù)雖然有所增高,但與觀察組B組存在差異,各時(shí)段以及不同組別HIE患兒兒心量表分值存在差異(P0.001),具有統(tǒng)計(jì)學(xué)意義。結(jié)論:通過(guò)兒心量表測(cè)試得到患兒發(fā)育商,能及時(shí)發(fā)現(xiàn)發(fā)育偏離的患兒,為臨床早期干預(yù)、改善預(yù)后、減少患兒傷殘?zhí)峁┛茖W(xué)依據(jù);新生兒期引入綜合治療措施,通過(guò)兒心量表各個(gè)能區(qū)量化評(píng)估,對(duì)薄弱能區(qū)進(jìn)行針對(duì)性強(qiáng)化干預(yù)治療,可在一定程度上改善新生兒缺氧缺血性腦病的預(yù)后,值得臨床推廣應(yīng)用。
[Abstract]:Objective: early intervention of neonatal hypoxic ischemic encephalopathy is not a simple drug treatment, the recovery takes a long time, means more expensive for parents to master the application of comprehensive rehabilitation methods for a simple and easy for clinical application is very important. Different time window scale observation of comprehensive intervention of children with developmental detection means taking and analyzed, judged, in order to seek a more effective comprehensive intervention and intervention time window to improve the neonatal hypoxic ischemic encephalopathy prognosis, is expected to reduce the possibility of disability, teratogenic and other sequelae. Importance: neonatal hypoxic-ischemic encephalopathy is the world's countries in the neonatal period the incidence of diseases of the nervous system is very high, with the progress of the disease fast, high mortality, neonatal injury, one of the reasons for disability. There is a lot of research shows that the neonatal hypoxia ischemia at home and abroad Encephalopathy consensus is not consistent, researchers have made a large number of studies suggest that it should be from the clinical symptoms, brain morphology, brain function, laboratory, comprehensive judgment imaging, the general prognosis assessment method for clinicians. Other research shows that the comprehensive judgment of the prognosis of neonatal HIE high sensitivity, but specificity in order to further lower the early prognosis objective evaluation with HIE (including sports, fine motor, language, social skills, adaptability, etc.) using the child heart scale caused by large movement of brain injury in children with fine motor, language and other aspects of quantitative monitoring, comprehensive treatment measures were introduced in different months age is the child heart scale assessment, monitoring and rehabilitation as an evaluation tool, in order to find a common master for clinicians and parents of intervention, and actively improve the prognosis, reduce long-term induced Abnormal, the occurrence of disability, and this therapy in clinical practice. Methods: 1. observation group from October 2015 2016 02 months admitted to our hospital for treatment of 174 cases of neonatal hypoxic ischemic encephalopathy in the observation group, all patients were diagnosed according to HIE standard. In the basis of the informed consent of the parents of children further randomly divided into A, B two groups: A group: 88 cases were given to three symptomatic neonatal 3D regular treatment of ganglioside and given 1 courses in the first 1,2,3 months of consolidation, the introduction of comprehensive intervention measures at fourth months (massage, infant exercise, audio-visual stimulation, massage, psychological support, exercise ability stimulation, which, for the weak region for intensive treatment); 86 cases in group B, HIE were the best treatment time window for postpartum 6h, to be in stable condition, on the basis of A, the neonatal period into comprehensive intervention measures; 2. Control group: select the same period in 80 normal children and children's Hospital of Department of health care as the control; 3. strict inclusion and exclusion criteria; 4. observation group and control group were child heart scale determination in 1,2,3,6,9,12 months, and data collection; results: This study showed that the exclusion of participants for various reasons lost and quit, and group B in the neonatal period began intervention compared to A group after comprehensive intervention of developmental quotient scores slightly lower relative to the B group, and in the sixth month development quotient score difference, although compared with the control group intelligence development slightly worse, but the intelligence development trend is similar to that of the control group infants with the increase of age, developmental quotient increased gradually with the general growth of infants, the observation group A group HIE patients after fourth months of intelligence although the index has increased, but the observation group and B group differences in each period and different groups of HIE patients Er Er heart score difference (P0.001), with statistical significance. Conclusion: the child heart scale test in children with developmental quotient, can discover the developmental deviation of children for early clinical intervention, improve the prognosis, and provide scientific basis for reducing the neonatal period of children with disabilities; introduce comprehensive treatment measures, the child heart scale each region can be quantitative evaluation, the weak region targeted intervention treatment can improve the prognosis of neonatal hypoxic ischemic encephalopathy in a certain extent, it is worthy of clinical application.

【學(xué)位授予單位】：河南科技大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R742

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