CAJ | 학술논문

目的：探讨早期应用全身运动(GMs)质量评估技术结合诱发电位(EPs)对预测高危新生儿运动发育的临床价值。方法选择112例儿童神经康复科门诊随访的高危新生儿，分别在GMs扭动运动阶段和不安运动阶段进行GMs评估和EPs检测，连续随访并在纠正年龄12月龄时根据2006年脑瘫(CP)诊断标准及Peabody运动发育量表确定其运动发育结局，计算全身运动质量、诱发电位以及两者结合的预测效度。结果112例研究对象运动发育结局，脑瘫26例(23.2%)、运动发育迟缓14例(12.5%)、正常72例(64.3%)。扭动运动阶段GMs及正中神经诱发电位(MNSEP)均异常对运动发育异常的预测灵敏度80.0%，特异度98.6%，阳性预测值97.0%，阴性预测值89.9%；不安运动阶段GMs异常对于脑瘫的预测灵敏度96.1%，特异度97.7%，阳性预测值92.6%，阴性预测值98.8%；GMs及MNSEP均异常预测效度无显著提高。两阶段中MNSEP均异常对运动发育异常的预测灵敏度82.5%，特异度91.7%，阳性预测值84.6%，阴性预测值90.4%。结论在扭动运动阶段联合GMs及MNSEP可提高对高危新生儿运动发育异常的预测效度。
목적：탐토조기응용전신운동(GMs)질량평고기술결합유발전위(EPs)대예측고위신생인운동발육적림상개치。방법선택112례인동신경강복과문진수방적고위신생인，분별재GMs뉴동운동계단화불안운동계단진행GMs평고화EPs검측，련속수방병재규정년령12월령시근거2006년뇌탄(CP)진단표준급Peabody운동발육량표학정기운동발육결국，계산전신운동질량、유발전위이급량자결합적예측효도。결과112례연구대상운동발육결국，뇌탄26례(23.2%)、운동발육지완14례(12.5%)、정상72례(64.3%)。뉴동운동계단GMs급정중신경유발전위(MNSEP)균이상대운동발육이상적예측령민도80.0%，특이도98.6%，양성예측치97.0%，음성예측치89.9%；불안운동계단GMs이상대우뇌탄적예측령민도96.1%，특이도97.7%，양성예측치92.6%，음성예측치98.8%；GMs급MNSEP균이상예측효도무현저제고。량계단중MNSEP균이상대운동발육이상적예측령민도82.5%，특이도91.7%，양성예측치84.6%，음성예측치90.4%。결론재뉴동운동계단연합GMs급MNSEP가제고대고위신생인운동발육이상적예측효도。
Objective To explore the clinical value of early application of general movements (GMs) combined with evoked potentials (EPs) in predicting motor development of high-risk neonates. Methods A total of 112 high-risk neonates in fol-low-up clinic of pediatric neurological rehabilitation were selected. GMs evaluation and EPs detection were measured in writhing movements period and ifdgety movements period respectively. The motor developmental outcomes were determined at the cor-rected age of 12 months after continuous follow-up according to the diagnostic criteria (2006) of cerebral palsy (CP) and Peabody motor development scale. The predictive validity of GMs, EPs and the combination of GMs and EPs was calculated. Results The motor developmental outcomes of 112 cases showed that there were 26 cases (23.2%) of CP, 14 cases (12.5%) of motor retar-dation and 72 normal cases (64.3%). In writhing movements period, the predictive validity of GMs in conjunction with median nerve somatosensory evoked potentials (MNSEP) for abnormal motor development was as follows:sensitivity 80%, speciifcity 98.6%, positive predictive value 97%, and negative predictive value 89.9%. In ifdgety movements period, the predictive validity of GMs for CP was as follows:sensitivity 96.1%, speciifcity 97.7%, positive predictive value 92.6%and negative predictive value 98.8%. However, the predictive validity of the combination of GMs and MNSEP for CP had no signiifcant increase. The predictive validity of MNSEP in both writhing movements period and ifdgety movements period for abnormal motor develop-ment was as follows:sensitivity 82.5%, speciifcity 91.7%, positive predictive value 84.6%and negative predictive value 90.4%. Conclusions In writhing movements period, combination with GMs and MNSEPs can improve the predictive validity for ab-normal motor development in high-risk neonates.