吴岸敏 李炜 吴柳芳 王丽珍

[摘要] 目的 探讨早期康复干预对缺氧缺血性脑损伤（HIBD）患儿智力发育水平及预后的影响。 方法 选取2014年1月～2016年3月于我院就诊的病情稳定的HIBD患儿80例，采用抛硬币法分为干预组和对照组各40例。对照组患儿给予常规干预措施，干预组患儿予以早期康复干预措施，两组均干预24个月。于干预12、24个月后比较两组患儿智能发育商评分变化，并比较神经系统后遗症发生率。 结果 干预12、24个月后，干预组患儿精细运动、适应、语言、社交和大运动等智能发育商各能区评分均明显高于对照组，差异有统计学意义（P<0.05）。干预24个月后，干预组患儿在神经系统后遗症发生率方面低于对照组，差异有统计学意义（χ2=4.11，P<0.05）。 结论 早期康复干预用于HIBD患儿的效果肯定，能显著改善智力发育水平，并能减少或预防神经系统后遗症发生，从而改善预后。

[关键词] 缺氧缺血性脑损伤；儿童；早期康复干预；智力发育；预后

[中图分类号] R742 [文献标识码] B [文章编号] 1673-9701（2018）30-0085-04

[Abstract] Objective To investigate the effect of early rehabilitation intervention on the intelligence development level and prognosis in the children with hypoxic-ischemic brain damage （HIBD）. Methods A total of 80 children with stable HIBD who were admitted to our hospital from January 2014 to March 2016 were selected. The tossing coin method was used to divide the patients into the intervention group and the control group， with 40 cases in each group. Patients in the control group were given routine intervention measures. The intervention group was given early rehabilitation intervention measures. Both groups of children patients were given intervention for 24 months. The changes in the intelligence development quotient scores after 12 and 24 months of intervention in the two groups of children were evaluated， and the incidence rate of neurological sequelae was compared. Results After 12 and 24 months of intervention， the scores of each zone of intelligence development quotients in the intervention group were significantly higher than those in the control group， such as fine exercise， adaptation， language， social communication and gross motor. The differences were statistically significant（P<0.05）. After 24 months of intervention， the incidence rate of neurological sequelae in the intervention group was lower than that in the control group， and the difference was statistically significant（χ2=4.11， P<0.05）. Conclusion Early rehabilitation intervention is effective in children patients with HIBD， which can significantly improve the level of intelligence development level and reduce or prevent the occurrence of neurological sequelae， thus improving the prognosis.

[Key words] Hypoxic-ischemic brain damage（HIBD）； Children； Early rehabilitation intervention； Intelligence development； Prognosis

缺氧缺血性腦损伤（hypoxic-ischemic brain damage，HIBD）是因围生期多种窒息因素导致新生儿的脑细胞发生缺氧缺血引起的病理性脑损伤，可引起儿童死亡或出现神经系统后遗症[1，2]。儿童HIBD的发病机制至今尚未完全研究清楚，无特效的干预治疗方法及手段[3，4]。最新研究发现早期康复干预对儿童HIBD具有肯定的效应，对患儿体格、智能及运动功能的发育及预后具有较好的改善作用[3，5]。本研究观察了早期康复干预对HIBD患儿智力及预后的影响，现报道如下。

1 资料与方法

1.1 一般资料

选取80例HIBD患儿，均是2014年1月～2016年3月在我院儿科就诊患儿。纳入标准：（1）符合制定缺氧缺血性脑病的诊断标准[6]，均具有明确的围产期缺氧病史，且病情较稳定；（2）临床表现较典型，病情为轻、中度，并通过CT或MRI等确诊。……