早期被动操结合主动运动训练对早产/低体重儿体格及智能发育的影响研究

doi:10.11852/zgetbjzz2020-1269

摘要/Abstract

摘要： 目的分析早期被动操结合主动运动训练对早产/低体重儿体格及神经心理发育的影响,为其在早产/低体重儿体格及神经心理发育中的促进作用提供循证依据。方法选取 2017年7月—2019年7月在金安区妇幼保健院高危儿门诊建档的218名早产/低体重儿作为研究对象,根据家长是否按照要求坚持对早产/低体重儿进行早期(校正6月龄前)被动操及主动运动训练的频率和持续时间不同进行分组,采用Gesell发育量表对研究对象进行神经心理发育评估,比较各组校正6月龄、12月龄时体格发育及Gesell评分情况。结果早期被动操及主动运动训练频率越高及持续时间越长,早产/低体重儿在校正6月龄与12月龄时其体格测量值及智能发育商数越高,差异有统计学意义(P＜0.05)。与训练频率≤1 d/周组相比,除校正6月龄头围外,训练频率2～3 d/周组及≥4 d/周组的早产/低体重儿在校正6月龄及12月龄时体重、身长和头围测量值及适应能力、大运动、精细动作能区发育商数更高(P＜0.05);与持续时间0～2个月组相比,持续时间5～6个月组的早产/低体重儿在校正6月龄及12月龄时体重、身长及适应能力、精细动作、社交行为等能区发育商数更高(P＜0.05)。结论家长坚持给予早产/低体重儿做被动操及主动运动训练对其体格和神经心理发育具有一定的促进作用。

关键词: 早产儿, 低出生体重儿, 被动操, 主动运动训练, 智能发育

Abstract: Objective To explore the effect of early assisted physical exercise and active exercise on physical and neuropsychological development of premature infants and low weight infants,so as to provide evidence for its role in facilitating the development of premature infants and low weight infants. Methods A total of 218 premature infants and low weight infants with gestational age less than 36 weeks or birth weight lower than 2 500 g were enrolled in this study from Maternal and Child Health Hospital,Jin'an District. Infants were divided into different groups according to the frequency and duration of the passive and active motor training based on the willing of their parents. The Gesell Development Scale was used to evaluate the neuropsychological development of the study subjects,and the Gesell scores of the three groups were compared at the corrected age of 6 and 12 months. Results The higher frequency and duration of early assisted physical exercise and active motor training tended to significantly increase the physical measurements and intelligence development quotients of preterm/low weight infants at corrected age of 6 and 12 months (P< 0.05). Compared with the group with training frequency ≤1 d/week,preterm/low weight infants in the 2—3 d/week and ≥4 d/week groups had higher weight,length,and head circumference measurements and higher developmental quotients in the adaptive,gross motor,and fine motor energy areas at the corrected age of 6 and 12 months,except for the head circumference at corrected age 6 months (P<0.05). Compared with the preterm/low birth weight infants who took training for 0—2 months,those who took training for 5—6 months had higher weight and length measurements and higher developmental quotients in the adaptive,fine motor,and social behavioral domains at the corrected age of 6 and 12 months (P<0.05). Conclusion Early assisted physical exercise and active motor training can effectively promote the physical and neuropsychological development of premature infants and low weight infants.

Key words: premature infants, low birth weight infants, assisted physical exercise, active motor training, mental development

中图分类号:

R174

蔡传兰, 李瑞, 沈萍, 胡学勤. 早期被动操结合主动运动训练对早产/低体重儿体格及智能发育的影响研究[J]. 中国儿童保健杂志, 2021, 29(4): 447-450.

CAI Chuan-lan, LI Rui, SHEN Ping, HU Xue-qin. Effect of early assisted physical exercise and active exercise on physical and neuropsychological development of preterm and/or low birth weight infants[J]. Chinese Journal of Child Health Care, 2021, 29(4): 447-450.

参考文献

[1] 闫俊梅,黄辉,李倩倩,等.2006～2016年11年间早产儿发生率及病死率的单中心研究[J].中国当代儿科杂志,2018,20(5):368-372.
[2] 曾丽香. 二孩政策放开后早产儿发生率及其结局的调查分析[J].湘南学院学报(医学版),2017,19(4):53-55.
[3] 孙燕,张瑜平,贾文智,等.早期干预对早产儿认知发育的影响[J].中国妇幼健康研究,2019,30(3):275-278.
[4] 刘维民,鲍秀兰,马磊,等.早期干预降低极低出生体重儿脑瘫发生率的临床研究[J].中国儿童保健杂志,2015,23(4):360-363.
[5] Spittle A,Orton J,Anderson PJ,et al.Early developmental intervention programmes provided post hospital discharge to prevent motor and cognitive impairment in preterm infants[J].Cochrane Database Syst Rev,2015,24(11):CD005495.
[6] 张娟,徐微. 被动操对早产儿生长发育的效果研究[J].世界最新医学信息文摘,2017,17(80):35.
[7] 高广佩. 被动操对早产儿体格发育和骨发育的效果研究[D]. 北京:协和医学院,2016.
[8] Valizadeh L,Sanaeefar M,Hosseini MB,et al.Effect of early physical activity programs on motor performance and neuromuscular development in infants born preterm:a randomized clinical trial[J].J Caring Sci,2017,6(1):67-79.
[9] Barros FC,Bhutta ZA,Batra M,et al.Global report on preterm birth and stillbirth (3 of 7):evidence for effectiveness of interventions[J].BMC Pregnancy Childbirth,2010,10(Suppl 1):3.
[10] 何春,付士强,罗函渝,等.早期综合干预对早产低体重儿体格发育和智力发展的影响分析[J].中国妇幼保健,2016,31(5):976-978.
[11] Sgandurra G,Lorentzen J,Inguaggiato E,et al.A randomized clinical trial in preterm infants on the effects of a home-basedearly intervention with the 'CareToy System'[J].PLoS One,2017,12(3):e0173521.
[12] Spittle A,Orton J,Anderson PJ,et al.Early developmental intervention programmes provided post hospital discharge to prevent motor and cognitive impairment in preterminfants[J].Cochrane Database Syst Rev,2015,24(11):CD005495.
[13] 陈爱锋,向超,曾雪燕. 早期干预在晚期早产儿不同时期的应用效果[J].中国当代医药,2019,26(22):196-199.
[14] Silveira RC,Mendes EW,Fuentefria RN,et al.Early intervention program for very low birth weight preterm infants andtheir parents:a study protocol[J].BMC Pediatr,2018,18(1):268.
[15] 孙继红,刘冉. 早期给予抚触、被动体操和运动训练对早产儿发育的影响研究[J].中国妇幼保健,2015,30(4):568-570.
[16] Ustad T,Evensen KA,Campbell SK,et al.Early parent-administered physical therapy for preterm infants:A randomized controlled trial[J].Pediatrics,2016,138(2):e20160271.
[17] 张娟,徐微. 被动操对早产儿生长发育的效果研究[J].世界最新医学信息文摘,2017,17(80):35.
[18] Lambert LM,Trachtenberg FL,Pemberton VL,et al.Passive range of motion exercise to enhance growth in infants following the Norwood procedure:a safety and feasibility trial[J].Cardiol Young,2017,27(7):1361-1368.
[19] 林莉. 早期综合干预对低出生体质量早产儿体格发育及神经心理发育的影响[J].中国医药指南,2019,17(21):82-84.
[20] van Hus J,Jeukens-Visser M,Koldewijn K,et al.Early intervention leads to long-term developmental improvements in very preterm infants,especially infants with bronchopulmonary dysplasia[J].Acta Paediatr,2016,105(7):773-781.
[21] 高广佩,陈京立. 被动操促进早产儿骨代谢的临床应用[J].中国儿童保健杂志,2016,24(2):163-165.
[22] Chacham S,Pasi R. Assisted physical exercise for preterm neonates[J].IndianPediatr,2018,55(2):111-112.
[23] Litmanovitz I,Erez H,Eliakim A,et al.The effect of assisted exercise frequency on bone strength in very low birth weight preterm infants:A randomized control trial[J].Calcif Tissue Int,2016,99(3):237-242.
[24] Vanderveen JA,Bassler D,Robertson CM,et al.Early interventions involving parents to improve neurodevelopmental outcomes of premature infants:a meta-analysis[J].J Perinatol,2009,29(5):343-351.
[25] Downs JA,Edwards AD,McCormick DC,et al.Effect of intervention on development of hip posture in very preterm babies[J].Arch Dis Child,1991,66(7):797-801.
[26] Valizadeh L,Sanaeefar M,Hosseini MB,et al.Effect of early physical activity programs on motor performance and neuromuscular development in infants born preterm:A randomized clinical trial[J].Aryan ShamiliJ Caring Sci,2017,6(1):67-79.
[27] Shaw SC,Sankar MJ,Thukral A,et al.Assisted physical exercise for improving bone strength in preterm infants less than 35 weeks gestation:A randomized controlled trial[J].Indian Pediatr,2018,55(2):115-120.