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目的比较全身运动质量评估(General movements assessment,GMs)不安运动阶段和Gesell发育量表(Gesell Developmental Test Scales,GDS)对早产儿运动发育结局的预测效度,及对两种评估方法和发育结局的一致性检测。方法对2011年6月-2013年6月共226例在本院儿童保健科随访的早产儿,在纠正5个月内采用GMs和GDS进行评估,在纠正12个月时临床诊断是否为脑瘫,并使用Peabody运动发育量表(Peabody Development Motor Scale 2,PDMS-2)确定其运动发育结局。对比分析两种评估方法的预测效度(包括敏感度、特异度、阳性预测值和阴性预测值),及与发育结局的相关性。结果 226例早产儿发育结局中运动发育正常176例,运动发育迟缓22例,脑瘫28例。不安运动阶段评估结果为正常者168例,异常为58例;GDS评估结果为正常者140例,异常为86例。不安运动及GDS预测脑瘫敏感度92.9%、71.4%,特异度83.8%、66.7%,阳性预测值44.8%、23.3%,阴性预测值98.8%、94.3%。不安运动及GDS预测运动发育结局敏感度88.0%、68.0%,特异度92.0%、70.4%,阳性预测值75.9%、39.5%,阴性预测值96.4%、88.6%。GDS和PDMS-2的一致性检验Kappa值0.306,P<0.05,GMs和PDMS-2评估的一致性检验Kappa值0.757,P<0.05,提示GMs、GDS对运动发育预测与发育结局均具有良好的一致性,GMs中不安运动阶段的预测与发育结局的一致性更高。结论 GMs的不安运动阶段能够超早期预测脑瘫等不良运动发育结局,在预测预后方面要优于GDS,能更早期的做出预测。
Objective To compare the predictive validity of the General movements assessment (GMs) phase and the Gesell Developmental Test Scales (GDS) on the outcomes of motor development in preterm infants, and to compare the predictive validity of the two assessment methods and developmental outcomes Consistency testing. Methods A total of 226 preterm infants who were followed up from June 2011 to June 2013 in our Department of Child Health Care were assessed with GMs and GDS within 5 months after correction. Whether clinical diagnosis was cerebral palsy at 12 months was corrected, The Peabody Development Motor Scale 2 (PDMS-2) was used to determine the motor development outcome. The predictive validity (including sensitivity, specificity, positive predictive value and negative predictive value) of the two evaluation methods were compared and analyzed with the correlation between developmental outcomes. Results 226 cases of developmental outcome in preterm children, 176 cases of normal exercise development, motor retardation in 22 cases, cerebral palsy in 28 cases. In the uneasy movement phase, 168 cases were normal and 58 cases were abnormal; 140 cases were normal GDS and 86 cases were abnormal. The sensitivity and sensitivity of GDS in predicting cerebral palsy were 92.9%, 71.4%, 83.8%, 66.7% respectively, positive predictive value 44.8%, negative predictive value 23.3%, and negative predictive value 98.8%, 94.3%. The sensitivities of uneasy exercise and GDS in prediction of exercise development were 88.0%, 68.0%, 92.0%, 70.4% respectively, the positive predictive value was 75.9%, 39.5%, the negative predictive values were 96.4%, 88.6%. The consistency test of GDS and PDMS-2 showed that the Kappa value was 0.306, P <0.05. The consistency test between GMs and PDMS-2 test showed that the Kappa value was 0.757, P <0.05, suggesting that GMs and GDS had good predictive value on both exercise development and development Consistency, the prediction of the phase of immobility in GMs is more consistent with the developmental outcome. Conclusions The disturbed phase of GMs can predict the adverse motor development outcomes such as cerebral palsy in the early stage and is superior to GDS in predicting the prognosis. It can make an earlier prediction.