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目的 评估新生儿缺氧缺血性脑病 (HIE)所致额叶皮质萎缩在神经精神发育方面的预后。方法 自1997年 4月至 1999年 9月对 5 18例额叶皮质发育不良患儿在抽搐发作、睡眠行为、注意能力、语言发育、神经运动、依恋情感和认知水平方面定期评价至 3岁龄。结果 4月龄后发生无热抽搐 86例 (16 6 % ) ,在 18～ 30月龄间出现热性惊厥 2 6例 (5 0 % )。 4月龄出现 1项以上睡眠异常 2 5 6例 (49 4 % ) ,18月龄有 2～ 3项睡眠异常 5 3例 (10 2 % )。 8月龄注意能力异常 194例 (37 5 % ) ,3岁龄 6 8例异常 (13 3% )。 18个月龄运动性语言发育迟缓15 6例 (30 1% ) ,在 3岁龄时 ,运动性语言发育落后或构音异常 6 9例 (13 3% )。 4～ 8月龄期间 ,运动发育持续迟缓 4 2 6例 (82 2 % ) ,平均得 78 2分。 3岁龄运动发育迟缓者 14 1例 (2 7 2 % ) ,其中脑性瘫痪 32例。在 15月龄 2 4例 (4 6 % )依恋情感发展落后。结论 额叶皮质发育不良预后良好 ,但部分可能有远期的后遗症。应在婴儿早期常规检查头部CT或MRI。有额叶皮质发育不良者 ,需定期检查评价神经运动、精神发育、注意能力、语言发育水平和睡眠行为、依恋情感、脑电图等。
Objective To evaluate the prognosis of neuropsychological development in frontal cortex atrophy caused by neonatal hypoxic-ischemic encephalopathy (HIE). Methods From April 1997 to September 1999, 5 18 children with frontal cortex dysplasia were regularly evaluated to 3 years old with convulsive seizures, sleep behavior, attentional ability, speech development, motor activity, attachment feelings and cognitive level age. Results There were 86 cases (16.6%) with no convulsion after 4 months and 26 cases (50%) with fever convulsion between 18 ~ 30 months. There were 256 cases (49.4%) with more than one sleep abnormality at 4 months of age, and 53 cases (102%) with 2 ~ 3 sleep abnormalities at 18 months old. There were 194 cases (37.5%) with abnormal abnormity at 8 months, and 68 cases (13.3%) at 3 years old. There were 15 6 cases (30.1%) of exercise-induced speech retardation at 18 months of age. At 3 years of age, 69 cases (13.3%) had underdeveloped speech or dysarthria. During 4-8 months of age, 426 cases (82.2%) continued to develop slowly, with an average of 78.2 points. 14 1 (22.2%) were 3-year-old with stunting, of which 32 were cerebral palsy. At 15 months of age, 24 cases (46%) developed a backward attachment mood. Conclusion The prognosis of frontal cortex dysplasia is good, but some may have long-term sequelae. Head CT or MRI should be routinely checked early in infancy. Have frontal cortex hypoplasia, regular examination to assess the nerve movement, mental development, attention, language development and sleep behavior, attachment feelings, EEG and so on.