早产儿、足月小于胎龄儿与听力损失关系的探讨

Analysis of relative factors for hearing loss in prematures and full term small gestational age infants

[目的]探讨早产儿、足月小于胎龄儿与听损失及其程度的关系,为临床诊治提供参考依据。[方法]应用脑干听觉诱发电位对不同胎龄早产儿、足月小于胎龄儿进行听力测试,以单侧耳V波反应阈>30dBnHz作为2-4kHz范围内听损失指标,并对高危因素进行逻辑回归分析。[结果]测试异常新生儿246名,发现听损失63例。胎龄<30周的早产儿3例,听损失3例(100%);胎龄30-34周47例,听损失22例(46.8%);胎龄34-37周的早产儿共171例,听损失30例(17.5%);胎龄>37周的足月小于胎龄儿25例,听损失8例(32%),不同胎龄发生听损失差异显著(P<0.001)。中、重度以上听损失12例,其中中-重度10例,极重度2例,胎龄与听损失程度呈负相关,胎龄越小,听损失越重(r=-0.378P<0.01)。不同低出生体重发生听损失也有显著差异(P<0.001)。测试正常新生儿52例,听损失1例(1.9%),与早产儿、足月小于胎龄儿发生听损失差异显著(P<0.01)。[结论]逻辑回归分析显示,听损失相关因素有早产、低出生体重、围生期感染、窒息及颅内合并症。听损失发生及程度与不同早产胎龄、低体重显著相关,足月小于胎龄儿也是听损失发生的相关因素。

[Objective] To explore the relation between the hearing loss & loss degree and prematures infants, full term gestational age infants. [Method] The hearing of different gestational age prematures and full term small gestational age infants were tested by auditory brainstem response (ABR), unilateral ear V-wave reaction >30 dBnHz was used as the injury index between 2-4 kHz with logistic regession analysis for the high risk factors. [Results] 246 unusual newborns were tested, 63 hearing loss infants were found. All the 3 prematures under 30 weeks gestational age suffered from hearing loss;22 from 47 prematures with the gestational age from 30 to 34 weeks suffered from hearing loss( 46. 8%);30 from 171 prematures with the gestational age from 34 to 37 weeks were found (17. 5%); 8 from 25 full term small gestational age(SGA) with hearing loss were found(32%). The prematures were obviously related to hearing loss(x2 = 26. 18 P<0. 001). From 12 medium & severe cases , 10 were medium and severe, 2 extreme severe. The preterm gestational age and the hearing loss was in negative correlation, the shorter the gestational age was, the more severe the hearing loss(r=-0. 378,P<0. 01) was. Difference relevent to hearing loss between the various low birth weight was also obvious(P<0. 001). 52 normal newborns were tested, while only one (1. 9%) with hearing loss was found, the difference as compared with prematures and full term small gestational age infants was obvious (P<0. 01). [Conclusion] The logistic regession analysis indicated the factors relevant to hearing loss were premature, low birth weight, perinatal stage infection, asphyxia, intracranial complication. The incidence and degree of hearing loss were obviously related to preterm gestational ages and low birth weights, the incidence was also related to full term small gestational age infants.