【摘要】：目的： 探索不安運動缺乏早期預測腦性癱瘓的預測效度及正常不安運動伴隨異常運動序列時對運動發(fā)育落后的預測意義。 方法： 研究對象為2012年6月至2013年3月就診于我院小兒神經(jīng)康復科的神經(jīng)發(fā)育高危兒，記錄其不安運動階段的全身運動并進行質量評估，在首次評估間隔1個月后對研究對象進行第二次評估，測定重測信度。全身運動質量評估的結果以第二次評估為準，研究對象隨訪至12個月以上，明確運動發(fā)育結局，通過計算評估的敏感性、特異性、陽性預測值和陰性預測值，探索不安運動缺乏對腦性癱瘓的預測效度；并將存在正常不安運動的研究對象按是否伴隨異常運動序列分為兩組，通過比較兩組研究對象的獨走月齡，探索不安運動伴隨異常運動序列對運動發(fā)育落后的預測意義。 結果： 本研究共納入51例研究對象，男32例，女19例，孕齡27～42周，，平均孕齡37.0±3.3周，出生體重1300～4500g，平均出生體重3060.9±780.2g。不安運動記錄時間為矯正胎齡后9～20周，平均13.5±2.8周。兩次評估結果的重測一致性為κ=0.60，P＜0.01。51例研究對象中，35例（68.6%）存在正常不安運動,15例（29.4%）不安運動缺乏,1例（2.0%）存在異常不安運動。不安運動缺乏者中14例（93.3%）運動發(fā)育結局為腦性癱瘓，不安運動缺乏對腦性癱瘓的預測敏感性為93.7%，特異性為97.1%，陽性預測值為93.8%，陰性預測值重測為97.1%。全身運動質量評估結果為不安運動存在的研究對象中，不伴隨異常運動序列的16例研究對象獨立行走月齡為11～14月，平均12.2±0.9月，伴隨異常運動序列的19研究對象獨立行走月齡為11～16月，平均13.8±1.4月，兩組獨立行走月齡的差異有統(tǒng)計學意義（t=4.153，P＜0.01）。 結論： ⑴不安運動缺乏對腦性癱瘓具有良好的預測效度。 ⑵不安運動伴隨異常運動序列對預測運動發(fā)育落后具有一定價值。
[Abstract]:Objective: to explore the predictive validity of early prediction of cerebral palsy due to the lack of restless movement and the predictive significance of abnormal motion sequence in patients with normal restless movement. Methods: from June 2012 to March 2013, the subjects of the study were children with high risk of nerve development who were admitted to the Department of Neurorehabilitation of our hospital from June 2012 to March 2013. A second assessment was conducted after the first assessment interval of 1 month to determine retest reliability. The results of the general exercise quality assessment were based on the second evaluation. The subjects were followed up to more than 12 months to determine the outcome of motor development. The sensitivity, specificity, positive predictive value and negative predictive value of the evaluation were calculated. To explore the lack of predictive validity of restless motion for cerebral palsy; The subjects with normal unsteady motion were divided into two groups according to whether or not they were accompanied by abnormal motion sequence. By comparing the age of the two groups, the predictive significance of the sequence of abnormal motion accompanied by uneasiness motion for the development of backward movement was explored. Results: a total of 51 subjects were included in the study, including 32 males and 19 females. The gestational age was 2742 weeks, the average gestational age was 37.0 鹵3.3 weeks, and the average birth weight was 1 300 鹵4 500 g, with an average birth weight of 3060.9 鹵780.2 g. The recording time of restless motion was 9 ~ 20 weeks (mean 13.5 鹵2.8 weeks) after corrected gestational age. The retest consistency of the two evaluation results was 魏 = 0.60 (P < 0.01.51), 35 cases (68.6%) had normal restless movement, 15 cases (29.4%) were lack of restless movement. One case (2.0%) had abnormal movement. 14 (93.3%) of the patients with restless motor deficiency had cerebral palsy. The predictive sensitivity, specificity and positive predictive value of restless motor deficiency for cerebral palsy were 93.7g, 97.1g, 93.8g, 93.3%, 93.3%, 93.3%, 93.3%, 93.3%, 93.3%, 93.3%, 93.3% respectively. The negative predictive value was 97. 1%. Among the subjects whose body motion quality evaluation results were restless motion, 16 subjects who were not accompanied by abnormal motion sequence walked independently for 11 to 14 months with an average age of 12.2 鹵0.9 months. The age of independent walking was 11 ~ 16 months (mean 13.8 鹵1.4 months) in 19 subjects with abnormal motion sequence. The difference between the two groups was statistically significant (t = 4.153, P < 0.01). Conclusion: 1 lack of restless movement has good predictive validity for cerebral palsy. 2 uneasiness motion accompanied by abnormal motion sequence has certain value in predicting motor developmental backwardness.
【學位授予單位】：吉林大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R742.3

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