Rennie Janet M, Hagmann Cornelia F, Robertson Nicola J
UCL Elizabeth Garrett Anderson Institute for Women's Health, University College London Hospitals, Huntley Street, London WC1E 6DH, UK.
Semin Fetal Neonatal Med. 2007 Oct;12(5):398-407. doi: 10.1016/j.siny.2007.07.006. Epub 2007 Sep 7.
We consider the range of childhood disabilities that have been attributed to perinatal hypoxic ischaemia at term and review the strength of evidence for each. The strongest evidence is for a causal link between acute profound hypoxic ischaemia and dyskinetic tetraplegic cerebral palsy (CP). Hemiplegic CP is not usually due to a perinatal hypoxic ischaemic insult at term; an important cause is focal cerebral infarction or 'stroke'. Characteristically, diplegic CP is seen in ex-preterm children with periventricular leukomalacia. Ataxic CP is unlikely to be due to perinatal asphyxia. Recent careful follow-up studies have shown that childhood survivors of perinatal hypoxic ischaemia are at risk for cognitive deficits even in the absence of functional motor disorders. There is no evidence that, in isolation, either attention deficit hyperactivity disorder or autism is caused by hypoxic ischaemia. As effective neuroprotective therapies are introduced, notably cooling, it is possible that the prevalence of CP may be reduced.
我们考虑了一系列被归因于足月围产期缺氧缺血性脑病的儿童残疾情况，并对每种情况的证据强度进行了回顾。最有力的证据表明，急性重度缺氧缺血与运动障碍型四肢瘫脑瘫（CP）之间存在因果关系。偏瘫型CP通常并非由足月围产期缺氧缺血性损伤所致；一个重要原因是局灶性脑梗死或“中风”。典型的双瘫型CP见于患有脑室周围白质软化症的早产儿童。共济失调型CP不太可能是由围产期窒息引起的。最近的仔细随访研究表明，即使没有功能性运动障碍，围产期缺氧缺血性脑病的儿童幸存者也有认知缺陷的风险。没有证据表明注意力缺陷多动障碍或自闭症单独由缺氧缺血引起。随着有效的神经保护疗法的引入，尤其是降温疗法，脑瘫的患病率有可能降低。
