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小儿脑性瘫痪是什么样的疾病??

12040婴幼育儿

小儿脑性瘫痪是什么样的疾病??                                                 
脑瘫是出生前到出生后一个月内发育时期非进行性脑损伤所致的综合征,主要表现为中   
枢性运动障碍和姿势异常。                                                       
                                                                               
小儿脑性瘫痪的病因                                                             
脑瘫的病因很多,既可发生于出生前,如各种原因所致的胚胎期脑发育异常等;也可发   
生在出生时,如新生儿窒息、产伤等;还可发生于出生后,如某些心肺功能异常疾病(   
先天性心脏病、呼吸窘迫症等)引起的脑损伤。                                     
根据文献,引起脑瘫的原因目前归纳起来主要有:新生儿窒息、黄疸、早产、妊娠早期   
用药、新生儿痉挛、低体重、急产、母体中毒、阴道流血、颅内出血、产程过长、前置   
胎盘、母患精神病、妊娠中毒症、吸入性肺炎、双胎、巨大儿、妊娠反应重、脐带绕颈   
、胎头吸引、臀位、横位、硬肿症等,其发病率约为2-3‰。                          
                                                                               
小儿脑瘫的表现                                                                 
脑瘫的表现由于病因及分型的不同而各种各样,但早期多见:(脑瘫婴儿前半期(6个月  
以内)的早期症状。)                                                           
1.身体发软及自发运动减少,这是肌张力低下的症状,在一个月时即可见到。如果持续 4个月以上,则可诊断为重症脑损伤,智力低下或肌肉系统疾病。                      
2.身体发硬,这是肌张力亢进的症状,在一个月时即可见到。如果持续4个月以上,可诊断为脑瘫.                                                                   
3.反应迟钝及叫名无反应,这是智力低下的早期表现,一般认为4个月时反应迟钝,6个 月时叫名无反应,可诊断为智力低下。                                              
4.头围异常:头围是脑的形态发育的客观指标,脑损伤儿往往有头围异常。              
5.体重增加不良、哺乳无力。                                                     
6.固定姿势,往往是由于脑损伤使肌张力异常所致,如角弓反张、蛙位、倒U字形姿势等.在生后一个月就可见到。                                                       
7.不笑:如果2个月不能微笑、4个月不能大声笑,可诊断为智力低下。                  
8.手握拳:如果4个月还不能张开,或拇指内收,尤其是一侧上肢存在,有重要诊断意义   
9.身体扭转:3-4个月的婴儿如有身体扭转,往往提示锥体外系损伤。                  
10.头不稳定:如4个月俯卧不能抬头或坐位时头不能竖直,往往是脑损伤的重要标志。
11.斜视:3-4个月的婴儿有斜视及眼球运动不良时,可提示有脑损伤的存在。           
12.不能伸手抓物:如4-5个月不能伸手抓物,可诊断为智力低下或脑瘫。               
13.注视手:6个月以后仍然存在,可考虑为智力低下。                                
                                                                                
                                                                             
有些脑损伤较轻微,在婴儿早期往往无明显症状,但在婴儿后半期(6-12个月)则有一   
些其他症状表现:                                                               
                                                                               
1.不能翻身6个月以后还不能翻身,有诊断意义。                                    
2.不使用下肢6-7个月不用下肢短暂地支持体重                                      
3.不用单手7-10个月的婴儿不用单手抓玩。                                         
4.手笨手的精细动作,如捏小东西、解扣、系腰带不灵活,不协调,在7-10个月出现有诊断意义。                                                                      
5.不能独坐7个月不能独坐。                                                   
6.不能抓站10个月不能抓站。                                                     
7.不会与人再见10个月以后有诊断意义。                                           
8.使用脚尖站立10个月还用脚尖站立。                                             
9.不能迈步13-15个月以后,还不会迈步。                                          
10.流口水及"吃手"12个月以后有诊断价值。                                        
                                                                               
                                                                               
                                                                               
脑瘫的主要伴随损害
                                                             
                                                                               
1.健康和体力的障碍:脑瘫病儿一般身长较正常儿童矮,营养亦差,常有呼吸障碍和易   
患呼吸道感染疾病。                                                             
2.智能、情绪问题,并发智能低下率最高,多动、情绪不稳,自闭亦多,智商测定困难    
3.癫痫据统计约有半数伴发癫痫。                                            
4.语言障碍由于发声、构音器官的运动障碍和四肢运动障碍、听觉障碍、智能和生长环   
境等原因导致。                                                                 
5.听觉障碍难听程度从高音到低音障碍种种不一,家长应早作听力检查。                
6.视觉障碍约20%的脑瘫病儿有眼的障碍,注要为内斜、外斜等眼球协调障碍,其次为眼  
震和凝视障碍及近视、上方视麻痹等。                                             
                                                                               
                                                                               
                                                                               
小儿脑瘫的康复医疗                                                             
                                                                               
1.关键:早期诊断、早期治疗、早期训练。                                         
2.目的:使脑瘫患儿身心等功能全面康复,即使他们在运动功能上、精神上获得最大限    
度的康复,达到生活自理,为其将来参与社会活动、劳动和工作奠定基础。             
3.全面康复医疗措施大体分为:                                                    \

1),运动康复包括粗大运动、精细运动、平衡能力和协调性训练。                     
2),生活自理能力训练和作业疗法以达到训练手的功能.

3),并存障碍治疗如及时控制癫痫发作,矫治视觉、听觉和口面功能障碍,改善和发展  
认知功能,进行语言训练。                                                       
4),培养良好心理素质,矫治情绪、纠正行为异常,增加患儿克服困难的信心,培养社  
会交往能力。    

5),促进智力发育,接受教育,学习文化。为将来参与社会活动创造条件。             
6),使用矫形器具,对已发生严重挛缩和畸形者可予骨科手术矫治。                  
                                                                               
                                                                               
                                                                               
小儿脑瘫的预防                                                                 
                                                                               
(一)出生前的预防:                                                           
                                                                               
1.实行婚前保健:对准备结婚的男女双方进行性卫生、生育和遗传病知识的指导;有关   
婚配、生育等问题的咨询及男女双方可能患影响结婚和生育的疾病进行医学检查,提出
医学意见。                                                                     
                                                                               
2.搞好孕期保健:定期产前检查;增加营养;防止感染性疾病的发生等。               
                                                                               
(二)围产期的预防                                                             
                                                                               
1.避免早产和低体重儿的出生                                                     
2.预防窒息和颅内出血                                                            
3.防治高胆红素血症                                                             
                                                                               
(三)出生后的预防                                                             
                                                                               
1.防止感染性疾病的发生。                                                       
(1)实行住院分娩,                                                             
  (2)注意保护新生儿的皮肤,                                                    
(3)保持新生儿脐部的干燥、清洁,                                              
(4)密切观察黄疸的消长,                                            
(5)注意观察前囟,                                                            
(6)实行母乳喂养                                                              
                                                                               
2.预防高热惊厥的发生。                                                         
                                                                               
3.正确对待腰椎穿刺:腰椎穿刺抽取少量脑积液用于检查,以了解疾病的性质和病情,   
                                                                               
为正确诊断和治疗提供依据,从而减少颅内疾病后遗症的发生。为此家长应密切配合,   
                                                                               
共同为患儿的健康负责。                                                          
                                                                                
                                     

2006/04/20
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