Han Qunfeng, 37, once worked as a bank manager. With a happy family and rich income, he gave birth to twins with cerebral palsy. The couple gave everything they could for their children's treatment. Han Qunfeng also resigned to take care of her son for 13 years, and finally drowned the two sons and attempted suicide because of despair. The incident received widespread attention from the whole society, with up to 100000 netizens participating in the appeal for light punishment.
A tragedy of human relations has become a public event. While we are thinking about how to establish a sound social security system, we have to face a medical topic - cerebral palsy. According to authoritative data, there are more than 40000 new children with cerebral palsy every year in China, and all kinds of children with birth defects add up to a huge number. How to strengthen prevention, reduce and control the birth defect rate from the source, and how to improve symptoms and improve the quality of life after the occurrence should also become an important part of public intervention. To this end, the reporter specially interviewed Professor Li Zhizhong, director of orthopedics department and doctoral supervisor of the First Affiliated Hospital of Jinan University.
About famous doctors: Li Zhizhong, doctor, director of orthopedics department of the First Affiliated Hospital of Jinan University (Guangzhou Overseas Chinese Hospital), chief physician, professor, doctoral supervisor.
Cerebral palsy is not only a medical problem but also a social problem
Cerebral palsy, also known as cerebral palsy and cerebral palsy, is a syndrome caused by non progressive brain injury and developmental defects from the beginning of pregnancy to infancy, mainly manifested as dyskinesia and abnormal posture. It is often associated with mental retardation, learning difficulties, epilepsy, sensory disorders, communication disorders, behavioral abnormalities and other abnormalities. This disease is complicated, with a high rate of disability, low intelligence, serious disability, and even inability to take care of themselves. It involves family, society, economy, emotion, education and other aspects. It is not only a medical problem, but also a serious social problem.
Premature birth is the most common cause of cerebral palsy
The causes of cerebral palsy are complex, involving various factors existing or appearing before, during and after birth. Sometimes no obvious cause can be determined, but hypoxia may be one of the most common factors. According to Professor Li Zhizhong's long-term observation and research, the common causes of diseases are: premature birth accounting for 32%, hypoxia accounting for 24%, birth injury accounting for 13%, congenital defects accounting for 11%, and acquired diseases accounting for 7%.
1. Congenital factors: brain malformation; The fetus is infected in the mother; Maternal oxidative disorder and metabolic disorder; Pregnancy poisoning and trauma; Maternal gonad cells are not fully developed due to long-term radiation exposure.
2. Delivery factors: severe asphyxia, dystocia or prolonged delivery; Inappropriate use of obstetric forceps causes neurological damage; Intrameningeal or intracerebral hemorrhage; Or placental malposition, placental insufficiency, etc., can cause hypoxia and paralysis. See more.
3. Acquired factors: Trauma and diseases, such as brain and vascular trauma, encephalitis, meningitis, tumor, measles, pertussis, meningeal hemorrhage and embolism in brain parenchyma, carbon monoxide, sulfur dioxide or manganese poisoning, can cause atrophy of brain parenchyma, hemorrhagic cerebral palsy, also more common.
Treatment and prognosis of cerebral palsy: cerebral palsy will cause lifelong disability, but active treatment can effectively improve it
Early detection of cerebral palsy in children with three major symptoms
According to Professor Li Zhizhong, early diagnosis and treatment will help children recover quickly. At present, the diagnosis can be made as early as 6 months to 1 year after birth, which mainly depends on the accurate medical history and clinical manifestations, including pregnancy history, whether there is dystocia and whether there is rescue or there is a history of rough assisted delivery; Whether there are symptoms after delivery, such as bulging of anterior fontanelle, jaundice, muscle twitching, rigidity of one or both limbs, and whether the lower limbs can be separated. A clear diagnosis can only be obtained after being checked by a doctor in a regular hospital, but parents can generally pay attention to the following aspects of the baby's performance:
1. The development of cerebral palsy infants is worse than that of normal infants of the same age. For example, the whole body is weak, weak, or the limbs are tight, easily frightened, seldom or excessively active, often choking and coughing when taking milk, and the crying voice is low or sharp. From February to March, they will not look up or smile; Will not turn over from April to May; 8 months without sitting or catching things; Poor intelligence; Easy to catch cold, etc.
2. Abnormal movements and postures. Such as: salivation; Wearing clothes and diapers are resistant; When learning to stand, the feet are close together, the toes are on the ground, and the legs are crossed; The movement of limbs is uncoordinated, and the head cannot be kept in the central position.
3. It is often accompanied by other obstacles. Such as: emotional instability, epilepsy, language retardation, hearing impairment, esotropia, tooth dysplasia, etc.
Cerebral palsy is a lifelong disability, but active treatment can effectively improve it
Cerebral palsy patients have little impact on life, and most of them can live to over middle age. The cause of death may not be related to cerebral palsy, which is mainly manifested by varying degrees of disability, which brings heavy burdens to families and society.
The brain lesion of cerebral palsy is permanent, so the function controlled by the central nerve cannot be completely recovered, but it can be improved. Generally, the more extensive the brain lesions are, the more difficult it is to recover.
Those with normal intelligence can recover to some extent through non-surgical treatment and functional training. If combined with successful surgical correction, further improvement can be achieved, creating better conditions for later rehabilitation. Generally, after early diagnosis and treatment, some patients are expected to better improve their symptoms. About 30% of the patients can try to enter the school and finally achieve economic independence. About 25% of patients are mentally and physically retarded and need care. The rest are disabled, involving economic, emotional and social aspects, bringing many problems and difficulties.
Professor Li said: At present, the treatment of sequelae of cerebral palsy is difficult and complex, involving many disciplines and aspects. Most patients are expected to improve and improve their quality of life. Once parents find that children have signs of cerebral palsy, they should go to the hospital for diagnosis as soon as possible, and early intellectual and psychological education and limb function exercise can generally achieve good results.
1. Comprehensive treatment should be adopted, including intelligence and language training, physical therapy, acupuncture, massage, stent and plaster orthopedics. This is a long and painful process. Parents need to have enough patience and love, and stick to it for a long time to get some improvement.
2. The purpose of orthopedic surgery is to equal length limbs, balance muscle strength, correct deformity and stabilize joints. The surgical methods can generally be divided into four categories: ① posterior rhizotomy; ② Neurotomy: neurotomy of nerve branches that innervate spastic muscles; ③ Tendon replacement, lengthening, cutting and other operations; ④ Osteotomy and correction, osteotomy and extension, osteotomy and fusion, etc. This is also the most commonly used treatment method for mild to moderate patients at present. This method can not improve the IQ of patients, but can significantly improve the mobility of patients' limbs. Some patients are expected to walk on the ground, and even achieve self-care.
3. Neurosurgery focuses on relieving spasm.
Professor Li reminded again that although cerebral palsy is a lifelong disability, the condition of children with cerebral palsy can be effectively improved after scientific and effective rehabilitation training. Parents should pay close attention to the growth and development of their children at ordinary times. Once any abnormality is found, do not delay, and pay close attention to treatment and training. Six months ago is the key period for the treatment of children with cerebral palsy. The early brain tissue of infants is in a period of vigorous growth and development. At this time, early intervention has significant effects. After treatment, movement disorders are easier to recover.
4 Key points: comprehensively "stop" cerebral palsy
Professor Li further pointed out that since the prognosis of cerebral palsy is poor and the consequences are very serious, prevention is particularly important. How to reduce the incidence of children with cerebral palsy should become the top priority of doctors and society.
1. First, before the birth of the child:
(1) Pregnant women should actively carry out early prenatal examination, do a good job in perinatal health care, and prevent the occurrence of congenital diseases in the fetus;
(2) Bad habits such as smoking and drinking should be given up, and drugs such as narcotics and sedatives should not be abused;
(3) Prevent influenza, rubella and other viral infections, and keep away from cats and dogs;
(4) Avoid contact with harmful and toxic substances such as radiation and frequent B-ultrasonic inspection.
2. Choose regular and conditional hospital delivery. Fetal asphyxia and intracranial hemorrhage caused by birth are an important cause of cerebral palsy in children. Premature birth and dystocia should be prevented. The medical staff should carefully deal with all aspects of delivery, and do a good job in all aspects of treatment of dystocia fetus. Therefore, it is a must for pregnant women's families to choose a regular hospital with surgical conditions for delivery. Once it is estimated that dystocia or hypoxia will occur, it is recommended to carry out a cesarean section as soon as possible.
3. Within one month after the birth of the fetus, it is necessary to strengthen nursing and reasonable feeding to prevent intracranial infection, brain trauma, etc.
4. Pregnant women with the following conditions should have prenatal examination as soon as possible:
(1) Older pregnant women (over 35 years old) or men over 50 years old;
(2) Consanguinity marriage;
(3) Have a history of unexplained abortion, premature delivery, stillbirth and neonatal death;
(4) Pregnant women have mental retardation or their close relatives have epilepsy, cerebral palsy and other genetic diseases. If fetal abnormalities are found early in pregnancy, pregnancy should be terminated as soon as possible.
