华西医学

华西医学

以循证医学为依据的脑性瘫痪早期诊断与早期干预

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《中国脑性瘫痪康复指南》(以下简称《指南》)是我国多领域专家学者于 2015 年完成编著的第 1 部脑性瘫痪(脑瘫)康复循证医学指南,《指南》提出了诊断脑瘫需满足的 4 项必备条件和 2 项参考条件。虽然依据我国《指南》可对脑瘫进行确定诊断,但脑瘫的早期诊断是否存在明确的年龄界定以及精准的预测方法,我国《指南》并未给出明确建议,国际上也尚无统一认识。近来有学者依据循证医学研究结果指出,历史上“潜在的或沉默的时期(12~24 个月龄前),无法确定是否是脑瘫”的认识已经过时,脑瘫或“脑瘫高风险状态”可在 6 个月的矫正年龄之前被准确地预测,并提出了早期诊断的标准化评估方案。该文就我国《指南》的相关阐述,以及国际上对于脑瘫早期诊断、早期干预的最新认识进行了介绍。

The Chinese Guideline for Rehabilitation of Cerebral Palsy (hereinafter referred as Guideline) is the first evidence-based guideline for rehabilitation of cerebral palsy, which was compiled by Chinese experts from different fields in 2015. The Guideline suggests that the diagnosis of cerebral palsy needs to meet four essential conditions and two reference conditions. Although the cerebral palsy can be diagnosed according to the Guideline, there is still the question that whether there is a clear age definition and standardized prediction methods for early diagnosis and accurate prediction of cerebral palsy. The Guideline does not give a clear definition of age and standardized prediction methods. There is no international unified understanding or specific recommendations as well. Recently, Dr Iona Novak and other experts have pointed out that the historical viewpoint of the latent or silent period (before the age of 12-24 months) has already been outdated, because cerebral palsy or " high risk of cerebral palsy” can be accurately predicted before the corrected age of 6 months and it is possible to accurately predicte whether it is cerebral palsy or " high risk of cerebral palsy” before the corrected age of 6 months. They proposed a standardized assessment program for early diagnosis. This article introduces and discusses the relevant descriptions of the Guideline and the latest international understanding of early diagnosis and intervention of cerebral palsy.

关键词: 脑性瘫痪; 循证医学; 早期诊断; 早期干预

Key words: Cerebral palsy; Evidence-based medcine; Early diagnosis; Early intervention

引用本文: 李晓捷, 唐久来. 以循证医学为依据的脑性瘫痪早期诊断与早期干预. 华西医学, 2018, 33(10): 1213-1218. doi: 10.7507/1002-0179.201805128 复制

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