早产极低出生体重儿听性脑干诱发电位特征分析

The characteristics of auditory brainstem response in preterm very low birth weight babies

目的:探讨早产极低出生体重儿(VLBW)听性脑干诱发电位(ABR)的特征,及其与患儿生理特征的关系。方法:选取本院新生儿病区、新生儿重症监护室及听力专科就诊接受检查的早产VLBW儿纳入研究,共59例(118耳),登记围产期高危因素;选取30例(60耳)同期足月正常出生体重儿作为对照组。对所有患儿进行中耳分析,畸变产物耳声发射和ABR。结果:早产VLBW儿中听力异常的构成比明显大于正常人群,伴有其他高危因素的患儿(42例)阈值高于不伴有其他高危因素者(17例);相关分析显示,ABR阈值与出生体重、孕周、评估时年龄和调整年龄之间没有相关性(P>0.05);ABRⅠ、Ⅲ、Ⅴ波潜伏期和Ⅰ-Ⅲ、Ⅲ-Ⅴ、Ⅰ-Ⅴ波间期等特征参数与患儿评估时年龄和调整年龄呈负相关(P<0.05);早产VLBW儿与足月儿在ABRⅠ、Ⅴ波潜伏期及Ⅰ-Ⅲ、Ⅲ-Ⅴ波间期等参数间存在差异。结论:早产VLBW儿导致听力损失的根本原因可能并不是胎龄和体重本身,而是与并发症有关;早产VLBW儿中,外周听觉功能异常率高;对于VLBW儿需建立耳声发射与自动ABR两者结合的听力筛查方式并定期随访。

Objective：To discuss the characteristics of auditory hrainstem response in preterm very low birth weight （VLBW） babies and to investigate the correlations between the ABR and clinical characteristics. Method： Fifty-nine VLBW babies （118 ears） were enrolled in the study and 30 term normal babies as the control group. Tympanometry, acoustic reflex, DPOAE, ABR were obtained in all the babies. Result： The prevalence of hearing loss in VLBW babies was higher than normal term babies and babies with perinatal complications higher than those without perinatal complications. There was no correlations between ABR threshold and gestational age, birth weight, posteonceptional age, negative correlations between wave Ⅰ , Ⅲ and Ⅴ latencies Ⅰ -Ⅲ , Ⅲ- Ⅴ and Ⅰ -Ⅴ intervals and posteonceptional age. Wave Ⅰ and Ⅴ latencies, Ⅰ-Ⅲ and Ⅲ-Ⅴ intervals differed significantly between the two groups. Conclusion：The perinatal complications were the most important causes of the hearing loss in preterm VLBW babies than the gestational age and birth weight. There was a high prevalence of peripheral hearing loss in the preterm VLBW babies. Combining OAE and automated ABR should be applied for hearing screening. Regular follow up was very important in all the preterm VLBW neonatal.