摘要
目的探讨儿童缺血性脑卒中(IS)远期预后并初步探讨影响其预后的因素。方法收集1992年1月至1997年5月首次入住首都医科大学附属北京儿童医院(我院)的IS连续病例。对住院病历进行回顾性分析,了解其发病时的病因、临床表现及影像学特征。愿意接受随访的患儿到我院随访,项目包括问卷调查、物理检查、日常生活活动(ADL)评定、智力测量、患肢运动功能评定(FMA评估)、头颅MRI和磁共振血管造影术(MRA)检查,分析IS的远期预后。结果 44例IS连续病例符合纳入标准,其中1例病初死亡,3例无法取得联系,15例拒绝随访。25例进入分析,其中男14例,女11例。起病至本次随访的间隔时间平均为12.2年,随访时平均年龄16.3岁(11.3～24.2岁)。①起病时23例表现为偏瘫症状,2例四肢瘫。10例患儿病因不明,呼吸道感染5例,轻微头外伤5例,Moyamoya病2例,同时呼吸道感染和头外伤1例,心脏病和脑动脉炎各1例。②5/25例起病入院时出现惊厥的患儿出院后未再出现惊厥;起病时未发生惊厥的2例患儿出现癫发作;2例Moyamoya病患儿出院后出现IS复发。③25例患儿肌力均较起病时提高;25例患儿ADL得分在118～126分,均符合ADL功能独立;FMA评分结果显示11例(44%)患儿患肢运动功能达到正常。④7例(28%)患儿全量表智商<70分;15例(60%)患儿存在心理问题,包括记忆力差11例,注意力不集中10例,自信心不强9例,动作过多7例,社交恐怖7例。⑤MRA检查显示3例起病时血管狭窄的患儿其狭窄程度明显减轻,余22例患儿无明显改变。⑥基底节、内囊和丘脑部位梗死者以及特发性脑卒中患儿FMA评分较高。结论儿童IS远期预后较好,均可达到生活自理。约50%患儿仍存在不同程度的运动功能障碍和心理问题,整体认知能力偏低。基底节、内囊和丘脑部位梗死和特发性IS者运动功能预后良好。
Objective To investigate the long-term outcome of pediatric ischemic stroke（IS） and influencial factors. Methods Patients who were admitted and given a discharge diagnosis of AIS from Beijng Children′s Hospital were identified . Only first admissions from January 1992 to May 1997 were recruited. By retrospective review, initial causal factors, characteristics of clinical presentations and imaging were analyzed. The patients received a series of face-to-face examinations in Beijng Children′s Hospital including questionnaire, physical examinations, activities of daily living（ADL）, intelligence quotient（IQ）, Fugl-Meyer assessment（MFA）, magnetic resonance imaging（MRI） and magnetic resonance angiography（MRA） scans of head. Results The records of 44 children were retrieved. One child died due to underlying disease. Three children were lost to follow-up. Fifteen patients were not willing to undergo follow-up examination. At last , 25（14 males） patients were included. The mean interval between the onset and the follow-up was 12.2 years. Age at follow-up ranged from 11.3 years to 24.2 years（mean 16.3 years）. ①23 children presented with hemiparesis and 2 with tetraplegia at onset. Five children presented with seizure at the time of stroke. In 10 patients, the cause of stroke remained unknown. Ischemic stroke occurred after mild head trauma in 5 patients and after infectious disorders in 5 patients. Moyamoya disease was found in 2 children. One case was with respiratory infection and head trauma. Heart disease and cerebral arteritis were found in 1 case, respectively. ②Five children with seizures at onset did not develop epilepsy during the follow-up, however, two cases without seizures at onset developed epilepsy. Recurrence was observed in 2 patients with Moyamoya disease. ③At follow-up, all of the 25 children were functionally independent with improved muscle strength and the score of FIM ranged from 108 to 126. FMA was 100 in 11patients which meant normal movement. ④The score of IQ in 7 patients was below 70. Psychological disorders, such as remembrance impairment（11 patients） , attention deficit（10 patients）, inferiority（9 patients）, hyperactivity（7 patients） and social phobia（7 patients） had been identified in up to 60% of the children. ⑤Basal ganglia and internal capsule infarction produced better prognosis of movement than other infarction. Patients with cryptogenic IS had better outcome of movement than others. ⑥Narrowness of cerebral vessels was lessened in 3 patients on head MRA, compared with that at onset. Conclusions Prognosis of pediatric arterial stroke was better than that of the adults. All of the children were functionally independent. About half of the children of IS presented motor or psychological disorders. There was a significant shift in cognitive function towards lower levels. Basal ganglia and internal capsule infarction produced better prognosis of motor than other infarction. Patients with cryptogenic IS had better outcome of movement than others.
出处
《中国循证儿科杂志》
CSCD
2011年第6期406-411,共6页
Chinese Journal of Evidence Based Pediatrics
基金
首都医学发展科研基金项目资助:2005-1012
关键词
缺血性脑卒中
远期预后
儿童
Ischemic stroke Long-term follow-up Children
作者简介
通讯作者邹丽萍，E-mail：zouliping21@hotmail．com
