Matsui K, Suzuki H, Hirayama Y, Kaga M, Kurokawa T
Division of Child Neurology, National Center Hospital for Mental, Nervous and Muscular Disorders, Kodaira, Tokyo.
No To Hattatsu. 1992 Sep;24(5):419-25.
Nineteen patients with severely handicapped children were divided into 3 groups; tube-fed patients (group 1, n = 8), oral-fed patients with dysphagia (group 2, n = 3) and oral-fed patients (group 3, n = 8). Clinical symptoms, past history, cranial CT, EEG, blink reflex and auditory brainstem response were evaluated in these patients. All patients of group 1 and 2 could not control head or sit by themselves. They needed naso-oral suction. However, nasal airway, intubation and tracheostomy were necessary only in group 1 patients. Five out of 8 patients of group 3 could control head and sit by themselves. No one needed naso-oral suction. CT revealed ventricular dilatation or prominent destructive lesions in group 1. However, patients of group 2 and 3 showed the lesions of mild to moderate degree. EEGs showed poorly developed background activities or electrical status epilepticus in group 1, while they showed relatively well-developed background activities with less prominent paroxysmal discharges in group 2 and 3. R2 component of blink reflex was absent bilaterally in 90% patients of group 1 and 2, while unilateral R2 at least was present in group 3. Feeding problems in severely handicapped children were affected by combination of cerebrum and brainstem involvements. Examination of cranial CT, EEG and blink reflex was useful to determine the method of feeding.
19名患有严重残疾儿童的患者被分为3组：管饲患者（第1组，n = 8）、吞咽困难的经口喂养患者（第2组，n = 3）和经口喂养患者（第3组，n = 8）。对这些患者的临床症状、既往史、头颅CT、脑电图、眨眼反射和听觉脑干反应进行了评估。第1组和第2组的所有患者都无法自主控制头部或坐立。他们需要鼻口吸引。然而，仅第1组患者需要鼻气道、插管和气管切开术。第3组的8名患者中有5名能够自主控制头部并坐立。没有人需要鼻口吸引。CT显示第1组有脑室扩张或明显的破坏性病变。然而，第2组和第3组的患者显示出轻度至中度的病变。脑电图显示第1组背景活动发育不良或存在癫痫持续状态，而第2组和第3组显示背景活动相对发育良好，阵发性放电不那么明显。第1组和第2组90%的患者双侧眨眼反射的R2成分缺失，而第3组至少存在单侧R2。严重残疾儿童的喂养问题受大脑和脑干受累情况的综合影响。头颅CT、脑电图和眨眼反射检查有助于确定喂养方法。
