目的 探讨箱庭疗法对学龄期Tourette综合征(TS)共患焦虑情绪儿童干预的临床效果.方法 将学龄期TS共患焦虑情绪儿童62例作为研究对象,随机分成两组,每组各31例.对照组采取药物、心理支持和行为治疗的常规方案;观察组在常规方案基础上,运用箱庭疗法.采用耶鲁抽动障碍整体严重程度量表(YGTSS)、焦虑症自评量表(SAS)和儿童社交焦虑量表(SASC),对患者进行疗效评价.结果 干预前观察组儿童YGTSS各因子评分、YGTSS总分、SAS总分及SASC总分与对照组比较,差异无统计学意义(P＞0.05);干预后观察组儿童YGTSS各因子评分、YGTSS总分、SAS总分及SASC总分均低于对照组,差异有统计学意义(P＜0.05).结论 箱庭疗法联合药物、心理支持和行为治疗可以明显缓解TS儿童的抽动症状和焦虑情绪,可作为早期干预手段.

OBJECTIVE:To study the clinical efficacy of interactive group sandplay versus individual sandplay in the treatment of preschool children with autism spectrum disorder (ASD).METHODS:A total of 80 ASD children, aged 4-6 years, were enrolled and randomly divided into experimental and control groups, with 40 children in each group. The children in the experimental group joined group sandplay with normal children at a ratio of 1: 3, and those in the control group were treated with individual sandplay. The Aberrant Behavior Checklist (ABC) and Autism Treatment Evaluation Checklist (ATEC) were used to evaluate the treatment outcome after three months of intervention.RESULTS:There were 33 children in the experimental group and 28 in the control group. After three months of intervention, the experimental group had significant reductions in the scores of irritability, social withdrawal, and stereotypic behavior and the total score of the ABC scale (P<0.05), and the control group had significant reductions in the scores of behavior and inappropriate speech and the total score of the ABC scale (P<0.05). Compared with the control group, the experimental group had significantly greater improvements in the score of social withdrawal and the total score of the ABC scale after three months of intervention (P<0.05). After three months of intervention, the experimental group had significant reductions in the scores of sociability, sensory and cognitive awareness, and physical/health behavior and the total score of the ATEC scale (P<0.05), and the control group had significant reductions in the scores of speech, sociability, and physical/health behavior and the total score of the ATEC scale (P<0.05). Compared with the control group, the experimental group had significantly greater improvements in the scores of speech, sociability, and sensory and cognitive awareness and the total score of the ATEC scale after intervention (P<0.01). Compared with the control group, the experimental group also had significantly greater improvements in eye contact and sand stereotyped arrangement (P<0.05).CONCLUSIONS:Both interactive group sandplay and individual sandplay are effective in the treatment of ASD in preschool children. Interactive group sandplay is better than individual sandplay in the treatment of ASD, with significant improvements in sociability, emotion and stereotypic behavior.

目的 评估0～3岁婴幼儿儿心量表筛查法的应用效果.方法 分层随机选取2015-2016年就诊于福建省妇幼保健院儿童心理保健科门诊0～3岁婴幼儿609例,以Gesell发育量表为金标准,对入选婴幼儿分别行Gesell发育量表诊断和儿-心量表筛查法测验.结果 在609例婴幼儿中,儿-心量表筛查法评定阳性组为247例,Gesell量表智能评定阳性组为212例.总样本及各月龄组小儿进行儿-心量表筛查法评估结果的灵敏度分别为91.0％、87.5％、92.6％、95.7％、92.9％、88.0％、92.0％、92.9％、87.5％;假阴性率(FNR)分别为9.0％、12.5％、7.4％、4.3％、7.1％、12.0％、8.0％、7.1％、12.5％;Kappa值分别为0.75、0.68、0.72、0.77、0.76、0.74、0.68、0.86、0.75.ROC曲线下面积(AUC) =0.827(P ＜0.01),95％置信区间(0.723～0.931).结论 应用0～3岁儿心量表筛查法操作较为便捷、可靠,该法部分月龄段条目进一步优化后可在福建省推广使用.

目的 探讨注射用鼠神经生长因子辅助治疗孤独症谱系障碍伴脑部发育不良患儿的临床效果.方法 以82例孤独症谱系障碍伴脑部发育不良患儿作为研究对象,随机分为观察组和对照组各41例.观察组给予综合治疗+注射用鼠神经生长因子治疗,对照组给予综合治疗.治疗后3个月和6个月各复查一次,比较两组治疗前后孤独症行为核查表(ABC量表)、儿童孤独症评定量表(CARS量表)、婴儿一初中学生社会生活能力量表(S-M量表)的分数和0～6岁小儿神经心理发育量表中发育商的变化.结果 治疗前观察组患儿ABC、CARS、S-M量表分数和各能区发育商、总发育商,与对照组比较差异无统计学意义(P＞0.05);治疗后3个月,观察组患儿ABC、CARS量表分数均低于对照组(P＜0.05),S-M量表分数与对照组比较差异元统计学意义(P＞0.05),观察组患儿除语言和社交能区外,其他能区和总发育商均高于对照组(P＜0.05);治疗后6个月,观察组患儿ABC、CARS和S-M量表分数,各能区发育商及总发育商均高于对照组(P＜0.05).结论 注射用鼠神经生长因子在治疗孤独症谱系障碍伴脑部发育不良患儿中有一定的疗效.

目的 了解0～12月龄早产儿神经心理发育水平及规律.方法 用《0～6岁儿童神经心理发育量表》,对某三甲妇幼保健院420例0～12月龄早产儿进行发育商(DQ)检测(大运动、精细运动、适应能力、语言和社交行为5个能区),并进行统计分析.结果 420例早产儿中,不同年龄段男女婴总发育商类似;男婴的社交评价高于女婴,其余各大能区男女婴差异均无统计学意义;多元线性回归分析结果显示,影响早产儿总发育商的主要因素是出生时体重、体检时身高及孕周.结论 应加强妇女孕期保健和营养,降低低体重、低胎龄儿的出生率,及早进行神经心理发育监测,以减少不良影响、增进婴幼儿的DQ水平.

Objective:To discuss the curative efficacy of auditory integration training(AIT) on global developmental delay(GDD) children's development of language and emotional-sociality.Method:Totally 144 cases diagnosed as GDD children were randomly divided into 3 groups,namely as treatment group,control group and blank control group.Cases in each group composed of 28 mild GDD children and 20 severe GDD children.Data on auditory sensitive frequency in ASSR tests by brainstem evoked potential equipment,the neuropsychological development checklist for children aged 0-6 years old,AIT efficacy questionnaire,patients' changing of language DQ,general DQ,as well as symptoms were collected before and 3 months after AIT treatment with digital auditory integration training instrument were adopted to access the overall efficacy.Result:Three months after the treatment,mild GDD patients in treatment group had significant improvement in language DQ and general DQ comparing with the status before treatment (P＜0.001).The severe GDD patients in treatment group and all patients in control group had no significant improvement in language DQ and general DQ comparing with the status before treatment (P＞0.05).All patients in blank control group showed significant decrease in language DQ and general DQ comparing with the status before treatment (P＜0.01,P＜0.05).3 months after the treatment,mild GDD patients in 3 groups had statistically significant difference (P＜0.001) in language DQ and general DQ,while the severe GDD patients in 3 groups had statistically significant difference (P＜0.05) in general DQ.Comparing in pairs after treatment,mild GDD patients in the treatment group and in the blank control group had very significant difference in language DQ and general DQ (P＜0.01,P＜ 0.01).Severe GDD patients in treatment group and in blank control group had relatively significant difference in general DQ (P＜0.05),Mild and severe GDD patients in the control group and in blank control group had relatively significant difference in general DQ (P＜0.05).Mild GDD patients in control group and in blank control group had no statistically significant difference in language DQ (P＞0.05).After 3 months of AIT,the average overall efficacy rate are 60.42％ in language and 72.92％ in social behavior,and the average overall efficacy rate was 20.83％ in emotional control ability.Conclusion:AIT can help to foster mild GDD children's language development,improve GDD children's social communication ability and emotion control ability.

目的 探讨出院后系统保健管理模式对早产儿家长遵医依从性的影响.方法 便利抽样法选取2014年1-6月福建省妇幼保健院新生儿重症救护中心(neonatal intensive care unit,NICU)和产科出院的早产儿家长150例,采用自愿原则将其分为观察组和对照组各75例.对照组采用常规保健管理模式,观察组采用早产儿出院后系统保健管理模式,比较两组早产儿家长的遵医依从性.结果 观察组早产儿家长遵医依从性明显优于对照组(P＜0.001).结论 出院后系统保健管理模式可有效提高早产儿家长的遵医依从性,从而保证早产儿的居家照护,提高早产儿的生活质量.

Objective To explore the short-term efficacy of auditory integration training (AIT) on neuropsychological development in children with expressive language disorder.Methods 168 cases diagnosed as expressive language disorder children were randomly divided into 4 groups with 42 cases in each group,namely as the treatment group 1 (Group A),the treatment group 2 (Group B),the control group (Group C) and the blank control group (Group D).Brain stem auditory evoked potential instrument was used to take ASSR tests on auditory sensitive frequency,and digital auditory integration training instrument was used for AIT treatment.The neuropsychological development scale for children aged 0-6 years old and AIT efficacy questionnaire were used to assess the overall efficacy which included adaptability DQ,language DQ and social behaviour DQ 3 months before and after the treatment,as well as changes of clinical symptoms in the 1st and 3rd month after the treatment in group A.Results Three months after the treatment,patients in Group A and Group B had obvious improvement in the language and the social behaviour DQ (t =-12.104--2.790,all P＜0.01),while Group C showed no significant improvement in the three DQs (t=-1.655--1.193,all P＞0.05).In Group D,patients＇ three DQs had significant decrease (t=2.509-3.371,all P＜0.05).Three months after the treatment,the changing of the language and the social behaviour DQs among the four groups had significant difference (F=16.192-35.544,all P＜0.01).Group B had the highest scores in the languagie DQ and the social behavior DQ(82.90±10.39,86.51±7.47).Group A was the second highest (73.75±15.45,83.91±9.20).Compared with blank control group,Group A and B had significant difference in adaptability DQ (P＜0.05).Group A and the control group had significant difference in the DQs of language and social behavior (P＜0.05).After 1 month of treatment,the average everal efficaey rate in Group A was 78.57％,65.24％,19.05％ in the language,social behaviour and emetional ce utrrott ability.And after 3 months of treatment,the average overall efficacy rate was 86.31％.73.81 ％.43.65c％ in the language,social behaviour and emotional control ability.Conclusion AIT can help to improve the expressive language disorder children's development level of language and social behavior,and hence has certain efficacy in improving expression language disorder children's language expression,social behaviour and emotional control.

目的 探讨应用企业管理理念实施早产儿出院后管理对早产儿智能发育和气质的影响.方法 采取随机对照的方法,将110例早产儿分为实验组和对照组,各55例.实验组采用企业管理理念实施早产儿出院后管理,对照组接受常规保健模式.共96例早产儿完成了研究.比较两组早产儿4月龄、6月龄和12月龄神经心理发育检查得分和2月龄小婴儿气质问卷、12月龄幼儿气质评估表得分情况.结果 实验组早产儿除4月龄精细动作和适应性能区发育商与对照组比较,差异无统计学意义(P＞0.05),其余各能区发育商及总发育商均高于对照组(P＜0.05);2月龄实验组和对照组早产儿气质类型差异无统计学意义(P＞0.05);12月龄实验组早产儿E组例数多于对照组早产儿(P＜0.05).结论 应用企业管理理念实施早产儿出院后管理可有效促进早产儿的智能发育和气质培养.

目的:评估小儿神经心理发育预警征象的应用效果.方法:选取福建省妇幼保健院0～3岁小儿1 490例,使用《0-6岁小儿神经心理发育检查表》对所有入选小儿进行智能发育检测,同时使用预警征象进行智能发育评估.结果:在1 490例小儿中,运用预警征象指标进行智能发育评估,发现阳性508例,阴性982例.以《0～6岁小儿神经心理发育检查表》进行智能发育检查结果为参照标准,3岁内各月龄组小儿进行预警征象评估的灵敏度分别为91.7％、95.9％、98.6％、91.3％、88.9％、86.3％、93.1％、82.1％;特异度分别为97.4％、97.5％、91.8％、96.3％、99.0％、98.4％、100.0％、95.8％、100.0％;正确指数分别为0.89、0.93、0.90、0.88、0.88、0.85、0.91、0.89、0.82,Kappa值分别为0.90、0.94、0.89、0.88、0.89、0.87、0.92、0.88、0.81.结论:预警征象评估法有较好的临床应用价值,但其预警指标尚待进一步完善.

OBJECTIVE:To explore the relationship between gene polymorphism of GABAA receptors and childhood autism by detecting rs140682, rs2081648 and rs140679 site of single nucleotide polymorphism (SNP) in GABAA receptors gene. METHODS:A total of 94 children with autism and 124 normal children were enrolled in a hospital from November 2010 to May 2011. Childhood autism rating scale (CARS) and autism behavior checklist (ABC) were used to evaluate or investigate the case group. After collecting venous blood and extracting the genome DNA, the allele and genotype of SNP rs140682, rs2081648 and rs140679 site in GABAA receptors gene were detected by PCR-RFLP. The allele and genotype of case group and control group were analyzed by χ(2) test, while the score of scales was analyzed by Spearman rank correlation analysis. RESULTS:The age of the case group was 5.12 ± 0.32, and it was 5.25 ± 0.27 in the control group (P < 0.05). In case group, the frequency of genotype CC, CT and TT of rs140682 site was 44, 41 and 9, while it was 48, 65, and 11 in control group (P > 0.05), respectively. The frequency of genotype AA, AG and GG of rs2081648 site was 8, 58 and 28 in case group, while it was 12, 49 and 63 in control group (P < 0.05), respectively. In case group, the frequency of genotype CC, CT and TT of rs140679 site was 15, 36 and 43, while it was 18, 59 and 47 in control group (P > 0.05), respectively. It was revealed by Spearman rank correlation analysis that of rs2081648 site, there was a positive correlation between genotype AG and sensation factor (S), social intercourse factor (R), and language factor (L) of autism behavior checklist (ABC) (r values were 0.149, 0.165 and 0.155, all P values < 0.05). A negative correlation between genotype GG and S, R, L and self-help factor (V) was proved (r values were -0.140, -0.173, -0.158 and -0.135, all P values < 0.05). There was a positive correlation between allele A and R and L factors (r values were 0.153 and 0.137, all P values < 0.05), while a negative correlation between allele G and R and L factors (r values were -0.153 and -0.137, all P values < 0.05). In case group, 42 children were diagnosed with mild-to-moderate autism, while 52 children were severe autism. There was no statistically significant correlation between allele or genotype of SNP rs140682 and rs140679 site and the degree of autism (P > 0.05). There was a positive correlation between allele A and genotype AG and the degree of autism (r values were 0.147 and 0.616, all P values < 0.05), while a negative correlation between allele G and genotype GG and the degree of autism (r values were -0.159 and -0.616, all P values < 0.05). CONCLUSION:The SNP rs2081648 site which located in GABAA receptors gene may be related to autism. No evidence for significant association between rs140682 and rs140679 site and autism was found.

【目的】分析小婴儿气质与早期智能发育的关系,探讨小婴儿气质对智能发育的近期影响。【方法】采用Carey儿童气质量表中的小婴儿气质问卷(EITQ,适用于1~4个月)与0~4岁小儿神经心理发育诊断量表,对146名小婴儿气质和智能发育水平进行评价。【结果】气质类型分布无性别差异。与积极的气质类型相比,消极气质类型小婴儿的早期智能发育可能倾向于落后。小婴儿坚持性与总发育商及语言、社交行为发育商呈显著负相关(P<0.05),情绪本质与总发育商呈显著负相关(P<0.05),反应强度与大运动发育商呈显著负相关(P<0.05),趋避性与适应能力发育商呈显著负相关(P<0.05),反应阈与社交行为发育商呈显著正相关(P<0.05)。【结论】小婴儿气质与早期智能发育有着密切的关系,评析气质维度的特点类型,对了解小婴儿的智能发展更为敏感、更有价值。