未通過聽力篩查的重癥監(jiān)護(hù)病房新生兒聽性腦干反應(yīng)特點(diǎn)分析

未通過聽力篩查的重癥監(jiān)護(hù)病房新生兒聽性腦干反應(yīng)特點(diǎn)分析梁佳;鄒彬;王冰目的探討重癥監(jiān)護(hù)病房未通過聽力篩查的新生兒聽性腦干反應(yīng)的特點(diǎn).方2014320155月單耳或雙耳未通過自動(dòng)判別聽性腦干反應(yīng)(AABR)或畸變產(chǎn)物耳聲發(fā)射(DPOAENICU(NICU,42530dB301(36.1%),NICU211(49.6%),NICUABR(P<0.05)ABRABR(41.52±20.35)dB,比較差異有統(tǒng)計(jì)學(xué)意義(P<0.05)NICUⅠ~Ⅴ波間期明顯較健康組延長(P<0.05)NICU新生兒聽力損失程度高于健康新生兒,ABRToinvestigatetheauditorybrainstemresponse(ABR)ofnewbornsintheneonatalintensivecareunit(NICU)afterhearscreeningfailure.MethodsTotestABRof833healthynewbornswithnoperinataldiseasesattheclinic,and425newbornsborninNICUwhofailedthehearingscreeningofmonauralorboth-earfromMarch2014toMay2015.Results49.6%ofchildren′swaveVresponsethresholdswere≥30dBintheNICUgroupand36.1%children′swaveVresponsethresholdswere≥30dBinhealthygroup.ThehearingabnormalityrateoftheNICUgroupwassignificantlyhigherthanthatofthehealthygroup(P<0.05);Theaverageauditorythresholdshealthyofthegroup[(19.76±6.59)dB]wassignificantlylowerthanthoseoftheNICUgroup[(41.52±20.35)dB](P<0.05);bothearlatencyforwavesⅠ,ⅢandⅤandinterpeaklatencyforwavesⅠ-ⅤinhealthygroupweresignificantlyshorterthanthoseinNICUgroup(P<0.05).ConclusionThehearinglossextentoftheNICUgroupisgreaterthanthatofthehealthygroup.TheABRabnormalityreflectsauditorypathwayisabnormal.【期刊名稱】《重慶醫(yī)學(xué)》【年(卷),期】2017(046)014【總頁數(shù)】3頁(P1931-1932,1937)【關(guān)鍵詞】誘發(fā)電位,聽覺,腦干;聽覺;聽力檢查;重癥監(jiān)護(hù)病房,兒科;聽性腦干反應(yīng);高危因素【作者】梁佳;鄒彬;王冰【作者單位】重慶醫(yī)科大學(xué)附屬兒童醫(yī)院耳鼻咽喉科,重慶400010;重慶醫(yī)科大學(xué)附屬兒童醫(yī)院耳鼻咽喉科,重慶400010;重慶醫(yī)科大學(xué)附屬兒童醫(yī)院耳鼻咽喉科,重慶400010【正文語種】中文【中圖分類】R764.5隨著急救醫(yī)學(xué)的發(fā)展，新生兒重癥監(jiān)護(hù)病房(neonatalintensivecareunit，NICU)中的高危新生兒存活率提高，但仍常伴有不同程度的后遺癥，其中之一就是聽力障礙。同時(shí)，聽力損失也是最常見的先天疾病之一，新生兒聽力損失的發(fā)病率為0.1%～0.3%，高于其他先天性疾病[1]。新生兒聽力損失病例中，大約50%具有聽力損失高危因素[2]。因此，明確新生兒聽力障礙的早期表現(xiàn)和高危因素，進(jìn)行早期篩查，對本病的預(yù)防和治療具有重要意義。目前，臨床公認(rèn)的評價(jià)聽力損失的重要指標(biāo)之一是聽性腦干反應(yīng)(auditorybrainstemresponse,ABR)，ABR能夠反映聽神經(jīng)到丘腦水平聽覺神經(jīng)系統(tǒng)的功能活動(dòng)。ABR201435NICUABR2014320155(DPOAENICU(NICU無圍生期疾病健康新生兒(健康組)進(jìn)行ABR833465368(37.3±4.37)d，平均出生體質(zhì)量(3109.51±21.78)g；NICU425251174齡(21.8±1.21)d，出生體質(zhì)量(2061±55.67)g。方法AABRInteracousticsEP25EAR3A3kΩ，19.1100～3000Hz200090dB10dB依次遞減或遞增，以能引出可重復(fù)記錄到的VABR30dBABRV2～4kHzdB的波V31～<51dB，中51～<71dB71～<90dB90dB[3]。DPOAEInteracoustics2f1f2,f2/f11.22,L1=65dBSPL,L2=55dBSPL。DPOAE(DPDP6dB。InteracousticsT235h公司),測試內(nèi)容包括鼓室圖和鐙骨肌反射。受試兒保持睡眠或清醒安靜狀態(tài)。鼓室導(dǎo)抗圖探測音為226Hz和1000Hz純音。SPSS14tχ2α=0.05，為差異有統(tǒng)計(jì)學(xué)意義。ABR30dB532(63.9%)，≥30dB301(36.1；2NICU30dB214(50.4%)，≥30dB211(49.6%)；7ABR1ABRABR(41.52±20.35)dB，差異有統(tǒng)計(jì)學(xué)意義(P<0.05)。ABRNICU2。兩組Ⅰ、Ⅲ、Ⅴ波波幅差異無統(tǒng)計(jì)學(xué)意義(P>0.05)，NICUABR≥30dB27498(35.8%)出現(xiàn)平坦鼓室圖，NICUABR≥30dB11536(31.3%NICU1ABRDPOAEHille等[4]報(bào)道了高危兒新生兒聽力障礙的發(fā)生率為2%～4%，遠(yuǎn)高于正常新生兒。Mehl[5]NICU20%～40NICU54.2NICU(P<0.05)，則進(jìn)一步說明NICU新生兒較普通新生兒更易發(fā)生聽力損失。NICU新生兒中高膽紅素血癥[6]、新生兒顱內(nèi)感染、新生兒窒息、新生兒缺氧缺血性腦病等各種圍生期疾病是聽力損失的高危因素。變[7]。NICUⅠ～Ⅴ波間期明顯較普通新生兒延長(P<0.05ABRIⅠ～Ⅴ波間期代表腦干聽覺中樞傳導(dǎo)時(shí)間，同時(shí)也反映腦干功能完整性。Jiang[8]報(bào)道了具有聽力損失高危因素新生兒Ⅰ～Ⅴ波間期較無聽力損失因素新生兒延長。Amin[9]通過對新生兒期、48NICUI-V波間期較無聽力損失高危因素的新生兒延長[8]。Lorenzo[10]報(bào)道了早產(chǎn)兒各聯(lián)系受生長發(fā)育緩慢的影響，延長了聽覺傳導(dǎo)時(shí)間，從而表現(xiàn)為Ⅰ～Ⅴ[11-12ABR612～16[14]。NICUNICUABR聽力障礙高危兒的聽力障礙發(fā)生率遠(yuǎn)高于正常新生兒，ABR90%的學(xué)齡前兒童患兒有分泌性中耳炎，150%[15隨著聽覺系統(tǒng)的發(fā)育成熟和(或)分泌性中耳炎的好轉(zhuǎn)，且圍生期疾病得到及時(shí)的治療，部分聽力異常的患兒聽力可恢復(fù)至正常范圍。因此，聽閾升高的患兒應(yīng)更加重視聽力的隨訪，在3個(gè)月齡時(shí)做一次全面的聽力學(xué)評估，以便早期發(fā)現(xiàn)永久性聽力損失，盡早給予必要的干預(yù)。ABR2～4kHzCT、磁共振成像(MRI)和耳聾基因等。NICUNICUABR【相關(guān)文獻(xiàn)】LaucksR.Universalhearingscreeningforcongenitalhearingloss[J].NorthFlorMed,2006,57(14):386-390.UusK,BamfordJ.Effectnessofpopulation-basednewbornhearingscreeninginEngland:agesofinterventionsandprofileofcases[J].Pediatrics,2006(117):887-893.[3]NortonSJ,GorgaMP,WidenJE,etal.Identificationofneonatalhearingimpairment:summaryandrecommendations[J].EarHear,2000(21):529-535.HilleET,vanStatenHI,VerkerkPH.PrevalenceandindependentriskfactorsforhearinglossinNICUinfants[J].ActaPediatrica,2007,96(8):1155-1158.MehlAL,FhomV.TheColoradonewbornheatingscreeningproject,1992-1999:onthethresholdofeffectivepopulation-baseduniversalnewbornhearingscreening[J].PediatrRes,2002,109(1):7.[61993[J].中國兒童保健雜志,2009,17(1):103-104.[7]羅仁忠,麥堅(jiān)凝,陳倩,等.感音神經(jīng)性聾患兒客觀測聽評估特征分析[J].中華耳鼻喉科雜志，2001,36(5):346-351.[8]JiangZD,BrosiDM,LiZH,etal.Brainstemauditoryfunctionatterminpretermbabieswithandwithoutperinatalcomplications[J].PediatrRes,2005,58(6):1164-1169.[9]AminS,CharafeddineL,GuilletR.Transientbilirubinencephalopathyandapneaofprematurityin28to32weeksgestationalageinfant[J].JPerinatol,2005,25(6):386-390.[10]LorenzoEA,deoliveiraxMH,UmemuraA,etal.Evokedresponseaudiometryaccordingtogenderandage:findingsandusefulness[J].RevBrasOtolaringol,2008,74(4):545-551.[11]AminSB,OrlandoM,EddinsA,etal.Inuteroironstatusandauditoryneuralmaturationinprematureinfantsasevaluatedbyauditorybrainstemresponse[J].JPediatr,2010,156(3):377-381.AgarwalKN.Ironandthebrainneurotransmitterreceptorsandmagneticresponsespectroscopy[J].BrJ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