《中国康复理论与实践》

《中国康复理论与实践》 ›› 2015, Vol. 21 ›› Issue (06): 683-688.

• 特稿 • 上一篇    下一篇

全身运动质量评估预测不同孕周早产高危儿神经发育结局的效度比较

林星谷 1，林小苗 2，邹林霞 2，宋雄 2   

  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2015-06-25 发布日期:2015-06-25

Predictive Validity of General Movements Assessment for Neurological Development Outcome of High-risk Premature Infants in Different Gestational Ages

LIN Xing-gu1, LIN Xiao-miao2, ZOU Lin-xia2, SONG Xiong2   

  1. 1. Guangxi Key Laboratory for Genomic and Personalized Medicine, Guangxi Medical University, Nanning, Guangxi 530021, China; 2. Guangxi Maternal and Child Health Hospital, Nanning, Guangxi 530021, China
  • Received:1900-01-01 Revised:1900-01-01 Published:2015-06-25 Online:2015-06-25

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摘要： 目的 比较全身运动(GMs)质量评估对不同孕周分组的早产高危儿神经发育结局的预测效度。方法 按照妊娠28~31+6周、32~33+6周、34~36+6周将 180例研究对象分为 A、B、C三组，分别进行扭动运动阶段 GMs和不安运动阶段 GMs评估。通过临床诊断方法和Gesell发育量表，评估随访对象12月龄的运动发育结局，比较GMs评估在不同孕周分组中的预测效度。结果 运动发育结局有 133例发育正常，47例发育迟缓，其中 10例脑瘫。对于运动发育异常的预测效度，扭动运动阶段 GMs敏感性 40.4%、特异性90.2%、阳性预测值59.4%和阴性预测值81.1%；不安运动阶段GMs敏感性27.7%、特异性99.2%、阳性预测值92.9%和阴性预测值 79.5%。不同孕周分组间的 GMs评估检出率无显著性差异(P=0.610, P=0.765, P=0.290)。结论 GMs评估特异性和阳性预测值中，不安运动缺乏的评估最高；其次是痉挛-同步性。GMs评估中不安运动缺乏及痉挛-同步性更能够准确区分运动发育结局有无异常。GMs评估对28~36+6周的早产儿神经运动发育异常检出率无显著性差异。

关键词: 全身运动, 评估, 孕周, 早产儿, 高危, 预测效度

Abstract: Objective To compare predicting validity of general movements (GMs) assessment for neurodevelopment outcome of high-risk premature infants in different gestational age. Methods 180 participants were divided into group A (28 to 31+6 gestational weeks), group B (32 to 33+6 gestational weeks) and group C (34 to 36+6 gestational weeks) according to gestational age, and evaluated by GMs assessments in the stage of writhing-movement and fidgety-movement respectively. They were evaluated with GMs assessment and Gesell developmental scale, and cerebral palsy was diagnosed clinically. Results 133 infants were normal and 47 infants with developmental delay, in which 10 were with cerebral palsy. The sensitivity was 40.4%, the specificity was 90.2%, the positive predictive value was 59.4%, the negative predictive value was 81.1% in the stage of writhing- movement; and it was 27.7% , 99.2% , 92.9% and 79.5% in the stage of fidgety-movement, respectively. There was no significantly difference in the detection rate among different age groups (P=0.610, P=0.765, P= 0.290). Conclusion The absent fidgety-movement (F-) is the highest, and cramped-synchronized (CS) is the secondly to predict the motor developmental outcome. There was no difference of GMs assessment to detect the neurodevelopmental outcome in premature infants of 28 to 36+6 gestational weeks.

Key words: general movement, assessment, gestational age, premature infants, high-risk, predictive validity