颈总动脉周围交感神经网剥脱切除术治疗脑性瘫痪患儿的疗效
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摘要
目的:观察脑性瘫痪患儿行颈总动脉周围交感神经网剥脱切除术治疗后流涎症状、吞咽障碍及认知功能变化。方法:回顾性分析我院2015年10月至2017年5月经不同方式治疗的74例脑性瘫痪患儿的临床资料,并将进行康复治疗的患儿37例,作为对照组,将进行颈总动脉周围交感神经网剥脱切除术治疗的患儿37例,作为观察组。对比两组患者治疗前后大脑中动脉血流动力学指标变化情况及流涎症状、吞咽障碍、认知功能改善情况。结果:治疗后,观察组大脑中动脉各血流动力学指标均优于对照组(P<0.05);观察组教师流涎分级法(TDS)评分、洼田饮水试验评分均较对照组低(P<0.05);观察组韦氏幼儿智力量表(WPPSI)评分较对照组高(P<0.05)。结论:脑性瘫痪患儿应用颈总动脉周围交感神经网剥脱切除术治疗,可对流涎、吞咽功能起到显著改善作用,同时可有效促进认知功能恢复。
Objective: To observe the changes of ptyalism,dysphagia and cognitive function in children with cerebral palsy after the exfoliation excision of the sympathetic nerve network around the common carotid artery. Methods: The clinical data of 74 children with cerebral palsy treated by different ways in our hospital from October 2015 to May 2017 were retrospectively analyzed. The 37 children who were treated by rehabilitation were taken as the control group. The sympathetic surroundings of common carotid artery Nerve net stripping resection of children treated 37 cases as the observation group. The changes of arterial hemodynamics indexes of cerebral artery,and the improvement of ptyalism,dysphagia and cognitive function in the two groups were compared. Results: After treatment,the hemodynamic indexes of the cerebral artery in the observation group were superior to those in the control group( P <0.05); the Teacher Drooling Scale( TDS) score and the water swallow test score in the observation group were lower than those in the control group( P < 0. 05); the score of Wechsler Preschool and Primary Scale of Intelligence( WPPSI) in the observation group was higher than that in the control group( P <0.05). Conclusion: The application of exfoliation excision of the sympathetic nerve network around the common carotid artery in the treatment of children with cerebral palsy can significantly improve ptyalism and swallowing function,and can effectively promote the recovery of cognitive function.
Objective: To observe the changes of ptyalism,dysphagia and cognitive function in children with cerebral palsy after the exfoliation excision of the sympathetic nerve network around the common carotid artery. Methods: The clinical data of 74 children with cerebral palsy treated by different ways in our hospital from October 2015 to May 2017 were retrospectively analyzed. The 37 children who were treated by rehabilitation were taken as the control group. The sympathetic surroundings of common carotid artery Nerve net stripping resection of children treated 37 cases as the observation group. The changes of arterial hemodynamics indexes of cerebral artery,and the improvement of ptyalism,dysphagia and cognitive function in the two groups were compared. Results: After treatment,the hemodynamic indexes of the cerebral artery in the observation group were superior to those in the control group( P <0.05); the Teacher Drooling Scale( TDS) score and the water swallow test score in the observation group were lower than those in the control group( P < 0. 05); the score of Wechsler Preschool and Primary Scale of Intelligence( WPPSI) in the observation group was higher than that in the control group( P <0.05). Conclusion: The application of exfoliation excision of the sympathetic nerve network around the common carotid artery in the treatment of children with cerebral palsy can significantly improve ptyalism and swallowing function,and can effectively promote the recovery of cognitive function.
引文
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[10]赵斌,高晶,薛晶晶.109例脑性瘫痪患儿康复治疗体会[J].中国实用神经疾病杂志,2015,18(6):76~77.
[11]于江龙,买尔阿芭,木塔力甫·努热合买提,等.颈总动脉周围交感神经网剥脱切除术对学龄前脑瘫患儿头部血供及认知情况的影响[J].中华神经外科杂志,2015,31(3):277~280.
[2]熊义英,刘晓威,刘颖,等.喉罩与气管插管全身麻醉在脑性瘫痪患儿手术中的应用及护理比较[J].中国医药导报,2015,12(5):141~143.
[3]闫宝锋,逯霞,苗伟,等.颈总动脉交感神经网剥脱术后脑瘫患儿脑电图及TCD监测指标改变的意义[J].新疆医科大学学报,2016,39(4):489~491.
[4]刘志刚,李华,李泽,等.颈总动脉周围交感神经网剥脱切除术联合Bobath法康复训练治疗3~6岁脑瘫患儿的临床效果观察[J].医学临床研究,2017,34(3):450~452.
[5]李晓捷,唐久来,马丙祥,等.脑性瘫痪的定义、诊断标准及临床分型[J].中华实用儿科临床杂志,2014,29(19):1520~1520.
[6]王利江,纪静丽,温淑静,等.脑性瘫痪患儿流涎的评估和治疗研究进展[J].中国康复理论与实践,2016,22(3):299~302.
[7]石磊,王建祥,彭翔,曹成安.洼田饮水试验和Gugging吞咽功能评估量表在老年亚急性脑出血患者中的应用价值[J].中国老年学杂志,2017,37(11):2688~2690.
[8]Cameron D,Craig T,Edwards B,et al.Cognitive orientation to daily occupational performance(CO-OP):a new approach for children with cerebral palsy[J].Phys Occup Ther Pediatr,2016,37(2):183~198.
[9]Jenny Abanto DDS MSc,Ortega A O,Marcelo Bonecker DDS MSc Ph D,et al.Impact of oral diseases and disorders on oral-health-related quality of life of children with cerebral palsy[J].Spec Care Dentist,2014,34(2):56.
[10]赵斌,高晶,薛晶晶.109例脑性瘫痪患儿康复治疗体会[J].中国实用神经疾病杂志,2015,18(6):76~77.
[11]于江龙,买尔阿芭,木塔力甫·努热合买提,等.颈总动脉周围交感神经网剥脱切除术对学龄前脑瘫患儿头部血供及认知情况的影响[J].中华神经外科杂志,2015,31(3):277~280.