全身运动质量评估联合颅脑超声对脑损伤高危儿运动发育结局的预测价值

摘要 目的：研究全身运动（GMs）质量评估和颅脑超声（CUS）在脑损伤高危儿运动发育结局中的预测价值。方法：选取2019年10月至2021年6月入住徐州医科大学附属医院新生儿重症监护室（NICU）具有脑损伤高危因素的早产儿605例，建立随访档案。入院24h、3d、7d内各做一次CUS检查，异常者每周复查1次直至出院，记录最异常结果。矫正胎龄36～40周行扭动运动GMs质量评估，矫正3～6月龄行不安运动GMs质量评估。矫正12月龄通过Gesell发育量表和小儿脑瘫诊断分型标准明确运动发育结局，分析GMs质量评估、CUS对不良运动发育结局和脑瘫的预测效度。结果：最终获得完整随访资料的脑损伤高危儿为536例，随访至12月龄的运动发育结局为运动发育正常424例，运动发育迟缓105例，脑瘫7例。扭动运动GMs质量评估对运动发育结局预测的敏感性为56.25%、特异性为82.78%；不安运动GMs质量评估对运动发育结局预测的敏感性为73.21%、特异性为98.82%；CUS对运动发育结局预测的敏感性为54.46%、特异性为94.34%。扭动运动GMs质量评估联合CUS对运动发育结局预测的敏感性为81.25%、特异性为81.13%；不安运动GMs质量评估联合CUS对运动发育结局预测的敏感性为84.82%、特异性为96.46%。GMs质量评估和CUS对脑瘫预测的敏感性和阴性预测值均为100.00%；联合应用GMs质量评估和CUS可明显提高对不良运动结局的敏感性及阳性预测值。结论：CUS对脑损伤高危儿的不良运动发育结局尤其是脑瘫具有良好的预测价值，GMs质量评估联合CUS可明显提升对脑损伤高危儿不良运动发育结局的早期预测价值。

Predictive Value of General Movements Quality Assessment Combined with Craniocerebral Ultrasound for Exercise Development Outcome of Children at High-Risk of Brain Injury

ABSTRACT Objective: To study the predictive value of General movements (GMs) quality assessment and craniocerebral ultrasound (CUS) for exercise development outcome of children at high-risk of brain injury. Methods: 605 premature infants with high-risk factors for brain injury who were admitted to the Neonatal Intensive Care Unit (NICU) of Xuzhou Medical University Affiliated Hospital from October 2019 to June 2021 were selected, and follow-up records were established. CUS examination was performed within 24 h, 3 d and 7 d after admission. Abnormal patients were re-examined once a week until discharge, and the most abnormal results were recorded. GMs quality assessment was performed during the writhing movement stage at 36 to 40 weeks of gestational age, and GMs quality assessment during the restless exercise stage at 3 to 6 months of age. exercise development outcome was determined by Gesell Developmental Scale and diagnostic classification criteria for cerebral palsy in children at 12 months of age. The predictive validity of GMs quality assessment and CUS in predicting adverse exercise development outcome and cerebral palsy were analyzed. Results: Complete follow-up data were obtained in 536 high-risk children with brain injury, and the results of exercise development were 424 cases of normal exercise development, 105 cases of exercise development retardation, and 7 cases of cerebral palsy at 12 months of age. The sensitivity, specificity of GMs quality assessment of twisting exercise was 56.25%, the specificity was 82.78%. The sensitivity of restless exercise GMs quality assessment was 73.21%, the specificity was 98.82%. CUS had a sensitivity of 54.46%, specificity of 94.34% in predicting the outcome of exercise development. The sensitivity of twisting GMs quality assessment combined with CUS was 81.25%, the specificity was 81.13%. The sensitivity of restless exercise GMs quality assessment combined with CUS was 84.82%, the specificity was 96.46%. The sensitivity and negative predictive value of GMs quality assessment and CUS for predicting cerebral palsy were both 100.00%. The combination of GMs quality assessment and CUS can significantly improve the sensitivity and positive predictive value of adverse exercise outcome. Conclusion: CUS has good predictive value for adverse exercise development outcome of high-risk infants with brain injury, especially cerebral palsy. GMs quality assessment combined with CUS can significantly improve the early predictive value for adverse exercise development outcome of high risk infants with brain injury.