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目的:探讨新生儿期后综合干预治疗缺氧缺血性脑病(HIE)对患儿体格、智能及运动发育的影响。方法:选择162例HIE中重度病例随机分为干预组86例和对照组76例。干预组从新生儿期后1个月开始进行综合干预治疗,内容包括①早期干预:按照鲍秀兰编著的“0~3岁早期干预大纲”制定干预措施;②药物干预:静滴胞磷胆碱、脑蛋白水解物,每天1次,10天为1疗程,平均2~3个疗程,每个疗程间歇20天;③高压氧治疗:平均疗程及间歇时间同药物干预;④康复训练:在随访过程中对有早期脑瘫表现的进行Vojta诱导疗法、理疗等康复训练。所有患儿于3、6、12、18个月进行智龄及发育商测定。结果:干预组在3、6、12、18个月时平均发育商均明显高于对照组,差异非常显著(P均<0.01)。大运动、精细动作、适应能力、语言、社交行为5个能区得分比较均有显著性差异(P<0.05)。18个月时干预组DQ<80分者6例,预后不良率(伤残率)为7.0%;对照组DQ<80分者22例,伤残率为28.9%,两组有非常显著性差异(P<0.01)。结论:HIE患儿在新生儿期后进行综合干预治疗能有效地促进智能及运动发育,改善预后,降低伤残率。
Objective: To investigate the effect of comprehensive intervention after neonatal treatment on physique, intelligence and motor development in children with hypoxic-ischemic encephalopathy (HIE). Methods: 162 moderate and severe cases of HIE were randomly divided into intervention group (n = 86) and control group (n = 76). Intervention group from the newborn one month after the start of a comprehensive intervention treatment, including ① early intervention: According to Bao Xiu-lan edited “0 ~ 3-year-old early intervention program” to develop interventions; ② drug intervention: Alkali, brain protein hydrolyzate, day 1, 10 days for a course of treatment, an average of 2 to 3 courses, each treatment interval of 20 days; ③ hyperbaric oxygen therapy: the average course of treatment and intermittent time with the drug intervention; ④ rehabilitation training: During follow-up, Vojta induction therapy and physical therapy training were performed on patients with early cerebral palsy. All children underwent intellectual age and developmental determinations at 3, 6, 12, and 18 months. Results: The average developmental quotient of the intervention group at 3, 6, 12 and 18 months was significantly higher than that of the control group (P <0.01). There were significant differences in scores of the five major energy areas such as big sports, fine motor, adaptability, language and social behavior (P <0.05). At 18 months, there were 6 cases with DQ <80 in the intervention group, the rate of malcondition was 7.0%; in the control group, 22 cases were DQ <80, the disability rate was 28.9%, there was a significant difference between the two groups (P <0.01). Conclusion: The comprehensive intervention treatment of neonates with HIE after neonatal period can effectively promote the intelligence and motor development, improve the prognosis and reduce the disability rate.