脑性瘫痪儿童运动功能与生存质量之间的相关性分析

关键词：脑瘫  生存质量  运动功能  相关性

Keywords:cerebral palsy  quality of life  motor function  relativity

摘要：

      摘要 目的：分析4—12岁脑瘫儿童运动功能与生存质量之间的相关性。 方法：以2014年4—6月期间在复旦大学附属儿科医院康复中心、上海市徐汇区华泾社区卫生服务中心儿童康复科、上海市闵行区江川社区卫生服务中心儿童康复科、上海市宝山区金惠康复医院和上海市浦东特殊教育学校接受康复干预的4—12岁的脑瘫儿童和家庭为研究对象，共90例脑瘫儿童和家长纳入研究，其中脑瘫儿童包括男性54例，女性36例，平均年龄（7.40±2.44）岁；4—7岁59例，8—12岁31例，采用中文版脑瘫儿童生存质量问卷（cerebral palsy quality of life, CPQOL）评价生存质量，采用中文版脑瘫粗大运动功能分级系统（gross motor function classification system, GMFCS）进行粗大运动功能分级。采用中文版脑瘫患儿手功能的分级系统（manual ability classification system, MACS）进行手功能分级，通过分析GMFCS、MACS与CPQOL各项分值之间的相关性明确脑瘫儿童运动功能与生存质量之间的关系。 结果：GMFCS分级与7个CPQOL分区中的5个分区有着较弱的相关性，其中与社会福祉和受容度、功能、参与能力与躯体健康、情绪健康与自尊4个分区为负相关（r=-0.29—-0.38，P＜0.05），表明GMFCS分级越高上述4个分区的分值就越低，也就是相关的生存质量就越低，此外GMFCS分级还与疼痛和残障的影响分区呈现较弱的正相关（r=0.28，P＜0.05），表明GMFCS分级越高，脑瘫儿童受到疼痛和残障的影响就越明显。与GMFCS相比，MACS只有与CPQOL的社会福祉和受容度、功能两个分区呈现更弱的相关性(r=-0.27，P＜0.01；r=-0.23，P＜0.05）。与较小年龄脑瘫儿童（4—7岁）相比年龄较大脑瘫儿童（8—12岁）的GMFCS分级与CPQOL各分区的相关性更为明显。 结论：粗大运动功能在一定程度上影响着脑瘫儿童的生存质量，与粗大运动功能相比手功能对生存质量的影响较小，较大年龄组脑瘫儿童的粗大运动功能与生存质量之间的关系更为密切。

Abstract:

      Abstract Objective: To analyze the relativity between motor functions and the quality of life in 4—12 years-old children with cerebral palsy (CP). Method: Children with CP between 4—12 years old and their families were enrolled from the rehabilitation center of Children's Hospital of Fudan University, rehabilitation departments of three community health service centers and one special-education school. Totally 90 children (54 male, 36 female) were enrolled with 7.40±2.44 years old. There were 59 children between 4—7 years old and 31 between 8—12 years old. The gross motor function was measured by using Chinese-version of gross motor function classification system (GMFCS). The quality of life was rated with Chinese-version of cerebral palsy quality of life questionnaire for Children (CPQOL). The fine motor function was measured by Chinese-version of manual ability classification system (MACS) as well. The relativities between GMFCS/MACS levels and CPQOL scores were analyzed separately. Result: Weak negative relation was found between GMFCS levels and four out of seven dimensions of CPQOL, including welfare and acceptance, function, participation and body health, emotion health and self-esteem (r=-0.29— -0.38, P＜0.05). A weaker positive relation was found between GMFCS levels and the dimension of pain and disability influence (rs=0.28, P＜0.05). The levels of MACS only had more weaker negative relation between two dimensions of CPQOL, including welfare and acceptance, function (r=-0.27，P＜0.01；r= -0.23，P＜0.05）. The relativity was much higher in older children (group of 8—12 years old) than in younger ones (group of 4—7 years old). Conclusion: The gross motor function could affect the quality of life in children with CP. The fine motor function affected the QOL lesser than gross motor function. The gross motor function level related much closer with the quality of life in older children with CP than in youngerones.