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婴幼儿脑损伤神经修复治疗专家共识
Expert consensus on neurorestorotherapy for infants/toddlers with brain injury
本共识所界定的婴幼儿脑损伤是指婴幼儿时期由于各种围产期高危因素、感染、创伤、意外窒息、中毒、脑血管病等所致的中枢神经损伤，临床表现为中枢性运动障碍、认知障碍、语言障碍、癫癎发作、视听障碍、社会交往和心理行为障碍等[1-3]。本界定不包括遗传代谢性疾病和先天性脑畸形所致的脑损伤。
神经修复治疗是通过采用神经保护、组织工程或细胞移植、神经电刺激、药物、早期干预和康复训练等各种综合干预措施，促进被破坏或受损害神经的再生修复和重塑，恢复神经功能[4]。婴幼儿期是神经发育的关键期，未成熟脑在结构和功能上都具有很强的可塑性。因此，神经修复治疗对婴幼儿脑损伤尤为重要。当前临床上对婴幼儿脑损伤的诊治尚无统一方案，存在认识不足或诊治过度等问题。基于这一背景，由中国医师协会神经修复学分会儿童神经修复学专业委员会发起，组织国内相关领域26位专家，共同制订了《婴幼儿脑损伤神经修复治疗专家共识》，目的在于为临床医师提供一个对婴幼儿脑损伤治疗有一定循证医学依据的方案。
共识意见的证据和推荐级别依照GRADE标准[5]。证据级别分为高、中、低和极低4级（表1）[6]。根据对共识推荐意见的证据支持级别、效益、风险、负担和费用的综合判断，推荐级别分为强推荐和弱推荐两种（表2）。强推荐的含义是大多数患者应该接受推荐的方案，弱推荐的含义是不同的选择适合不同的患者。GRADE对推荐强度的二元分类的优点在于它为患者、临床医生和决策者提供了明确的方向，这尤其适用于缺乏高级别循证医学证据的临床情况，也常是共识制订时选择的分级方法。
No abstract available
[1] Pisani F, Pavlidis E, Facini C, et al. A 15-year epileptogenic period after perinatal brain injury[J]. Funct Neurol, 2017, 32(1):49-53.
[2] Stéphane M, Laetitia MM, Jean-Charles P, et al. Brain injury in very preterm children and neurosensory and cognitive disabilities during childhood:the EPIPAGE cohort study[J]. PLoS One, 2013, 8:e62683.
[3] Dadwal P, Mahmud N, Sinai L, et al. Activating endogenous neural precursor cells using metformin leads to neural repair and functional recovery in a model of childhood brain injury[J]. Stem Cell Reports, 2015, 5(2):166-173.
[4] Huang HY, Chen L. Neurorestorative process, law, and mechanisms[J]. J Neurorestoratology, 2015, 3:23-30.
[5] Atkins D, Best D, Briss PA, et al. Grading quality of evidence and strength of recommendations[J]. BMJ, 2004, 328(7454):1490.
[6] Balshem H, Helfand M, Schunemann HJ, et al. GRADE guidelines:3. Rating the of evidence[J]. J Clin Epidemiol, 2011, 64(4):401-406.
[7] 邵肖梅, 叶鸿瑁, 丘小汕. 实用新生儿学[M]. 第4版. 北京:人民卫生出版社, 2011:699-724.
[8] 陈光福. 实用儿童脑病学[M]. 北京:人民卫生出版社, 2016:128-164, 204-232, 277-359, 533-566, 716-740.
[9] 江载芳, 申昆玲, 沈颖. 诸福棠实用儿科学[M]. 第8版. 北京:人民卫生出版社, 2015:854-864, 981-1003, 2039-2046.
[10] Jacobs SE, Berg M, Hunt R, et al. Cooling for newborns with hypoxic-ischaemic encephalopathy[J]. Cochrane Database Syst Rev, 2013(1):CD003311.
[11] Lindsay PJ, Buell D, Scales DC. The efficacy and safety of prehospital cooling after out-of-hospital cardiac arrest:a systematic review and meta-analysis[J]. Crit Care, 2018, 22(1):66.
[12] Clifton GL, Valadka A, Zygun D, et al. Very early hypothermia induction in patients with severe brain injury (the National Acute Brain Injury Study:Hypothermia Ⅱ):a randomised trial[J]. Lancet Neurol, 2011, 10(2):131-139.
[13] Beez T, Steiger HJ, Etminan N. Pharmacological targeting of secondary brain damage following ischemic or hemorrhagic stroke, traumatic brain injury, and bacterial meningitis-a systematic review and meta-analysis[J]. BMC Neurol, 2017, 17(1):209.
[14] EI Sayed I, Zaki A, Fayed AM, et al. A meta-analysis of the effect of different neuroprotective drugs in management of patients with traumatic brain injury[J]. Neurosurg Rev, 2018, 41(2):427-438.
[15] Sheng L, Li Z. Adjuvant treatment with monosialoganglioside may improve neurological outcomes in neonatal hypoxicischemic encephalopathy:a meta-analysis of randomized controlled trials[J]. PLoS One, 2017, 12(8):e0183490.
[16] Zhao M, Li XY, Xu CY, et al. Efficacy and safety of nerve growth factor for the treatment of neurological diseases:a metaanalysis of 64 randomized controlled trials involving 6,297 patients[J]. Neural Regen Res, 2015, 10(5):819-828.
[17] Fischer HS, Reibel NJ, Bührer C, et al. Prophylactic early erythropoietin for neuroprotection in preterm infants:a Metaanalysis[J]. Pediatrics, 2017, 139(5). pii:e20164317.
[18] Chou HH, Chung MY, Zhou XG, et al. Early erythropoietin administration does not increase the risk of retinopathy in preterm infants[J]. Pediatr Neonatol, 2017, 58(1):48-56.
[19] Zhang L, Wu MQ, Hao ZL, et al. Clinical characteristics, treatments, and outcome of patients with anti-N-methyl-Daspartate receptor encephalitis:a systematic review of reported cases[J]. Epilepsy Behav, 2017, 68:57-65.
[20] Macnow TE, Waltzman ML. Carbon monoxide poisoning in children:diagnosis and management in the emergency department[J]. Pediatr Emerg Med Pract, 2016, 13(9):1-24.
[21] Figueroa XA, Wright JK. Hyperbaric oxygen:B-level evidence in mild traumatic brain injury clinical trials[J]. Neurology, 2016, 87(13):1400-1406.
[22] 邵肖梅, 桂永浩. 胎儿和新生儿脑损伤[M]. 上海:上海科技教育出版社, 2008:429-441, 491-498.
[23] Akbari E, Binnoon-Erez N, Rodrigues M, et al. Kangaroo mother care and infant biopsychosocial outcomes in the first year:a meta-analysis[J]. Early Hum Dev, 2018, 122:22-31.
[24] Meyer MJ, Megyesi J, Meythaler J, et a1. Acute management of acquired brain injury Part Ⅲ:an evidence-based review of interventions used to promote arousal from coma[J]. Brain Inj, 2010, 24(5):722-729.
[25] Lei J, Wang L, Gao G, et al. Right median nerve electrical stimulation for acute traumatic coma patients[J]. J Neurotrauma, 2015, 32(20):1584-1589.
[26] Georgiopoulos M, Katsakiori P, Kefalopoulou Z, et al. Vegetative state and minimally conscious state:a review of the therapeutic interventions[J]. Stereotact Funct Neurosurg, 2010, 88(4):199-207.
[27] Zhang H, Wang X, Li Y, et al. Naloxone for severe traumatic brain injury:a meta-analysis[J]. PLoS One, 2014, 9(12):e113093.
[28] 中华医学会肠外肠内营养学分会儿科学组, 中华医学会儿科学分会新生儿学组, 中华医学会小儿外科学分会新生儿外科学组. 中国新生儿营养支持临床应用指南[J]. 中华小儿外科杂志, 2013, 34(10):782-787.
[29] Robinson KE, Kaizar E, Catroppa C. Systematic review and meta-analysis of cognitive interventions for children with central nervous system disorders and neurodevelopmental disorders[J]. J Pediatr Psychol, 2014, 39(8):846-865.
[30] Morgan C, Novak I, Dale RC, et al. GAME (Goals-ActivityMotor Enrichment):protocol of a single blind randomised controlled trial of motor training, parent education and environmental enrichment for infants at high risk of cerebral palsy[J]. BMC Neurol, 2014, 14:203.
[31] 中国康复医学会儿童康复专业委员会, 中国残疾人康复协会小儿脑性瘫痪康复专业委员会,《中国脑性瘫痪康复指南》 编委会. 中国脑性瘫痪康复指南(2015):第六部分[J]. 中国康复医学杂志, 2015, 30:1322-1330.
[32] Wright PA, Durham S, Ewins DJ, et al. Neuromuscular electrical stimulation for children with cerebral palsy:a review[J]. Arch Dis Child, 2012, 97(4):364-371.
[33] 中国康复医学会儿童康复专业委员会, 中国残疾人康复协会小儿脑性瘫痪康复专业委员会, 《中国脑性瘫痪康复指南》 编委会. 中国脑性瘫痪康复指南(2015):第七部分[J]. 中国康复医学杂志, 2016, 31:118-125.
[34] 国家卫生和计划生育委员会新生儿疾病筛查听力诊断治疗组. 婴幼儿听力损失诊断与干预指南[J]. 中华耳鼻咽喉头颈外科杂志, 2018, 53(3):181-188.
[35] Gisel E. Interventions and outcomes for children with dysphagia[J]. Dev Disabil Res Rev, 2008, 14:165-173.
[36] Tan C, Liu Y, Li W, et al. Transcutaneous neuromuscular electrical stimulation can improve swallowing function in patients with dysphagia caused by non-stroke diseases:a metaanalysis[J]. J Oral Rehabil, 2013, 40(6):472-480.
[37] Chen YW, Chang KH, Chen HC, et al. The effects of surface neuromuscular electrical stimulation on post-stroke dysphagia:a systemic review and meta-analysis[J]. Clin Rehabil, 2016, 30(1):24-35.
[38] 田伟, 王征美, 孙岚. 中西医结合康复治疗持续植物状态的分析与探讨[J]. 辽宁中医杂志, 2012, 39(5):892-894.
[39] 栾佐. 细胞移植治疗小儿严重脑损伤及神经残疾专家共识[J]. 中华细胞与干细胞杂志, 2015, 5(4):1-11.
[40] Corti M, Patten C, Triggs W. Repetitive transcranial magnetic stimulalion of motor cortex after stroke:a focused review[J]. Am J Phys Med Rehabil, 2012, 91(3):254-270.
[41] Chudy D, Deletis V, Almahariq F, et al. Deep brain stimulation for the early treatment of the minimally conscious state and vegetative state:experience in 14 patients[J]. J Neurosurg, 2018, 128(4):1189-1198.
[42] Poiani GDCR, Zaninotto AL, Carneiro AMC, et al. Photobiomodulation using low-level laser therapy (LLLT) for patients with chronic traumatic brain injury:a randomized controlled trial study protocol[J]. Trials, 2018, 19(1):17.
[43] Gao X, Deng L, Wang Y, et al. GDNF enhances therapeutic efficiency of neural stem cells-based therapy in chronic experimental allergic encephalomyelitis in rat[J]. Stem Cells Int, 2016:1431349.
[44] Luo H, Xu C, Liu Z, et al. Neural differentiation of bone marrow mesenchymal stem cells with human brain-derived neurotrophic factor gene-modified in functionalized self-assembling peptide hydrogel in vitro[J]. J Cell Biochem, 2017 Sep 19. doi:10.1002/jcb.26408.[Epub ahead of print].
[45] Liu R, Liang ZJ, Liao XX, et al. Enhanced external counterpulsation improves cerebral blood flow following cardiopulmonary resuscitation[J]. Am J Emerg Med, 2013, 31(12):1638-1645.
[46] Guyatt GH, Oxman AD, Kunz R, et al. Going from evidence to recommendations[J]. BMJ, 2008, 336(7652):1049-1051.
