高胆红素血症新生儿听力损伤的研究

The study on hearing injury of neonates with hyperbilirubinemia

目的通过对高胆红素血症新生儿进行畸变产物耳声发射(DPOAE)及听性脑干反应(ABR)检测,了解其听力损伤的特点,为早期干预提供依据。方法对105例足月高胆红素血症新生儿进行DPOAE检查,其中有17例急性胆红素脑病患儿同时进行ABR检测。105例新生儿根据胆红素水平分为轻、中、重度3组,中、重度黄疸新生儿再分为溶血组与非溶血组,对其检测结果进行统计学分析。结果高胆红素血症患儿DPOAE总异常率为33.7%。DPOAE异常率随着胆红素浓度增高逐渐增高,42 d后逐渐恢复;溶血组DPOAE异常率(48%)较非溶血组异常率(35.23%)高;胆红素脑病组ABR的异常率(61.76%)与DPOAE异常率比较(47.06%)无统计学意义。结论高胆红素血症可引起新生儿耳蜗功能异常,但可逐渐恢复。新生儿溶血是引起胆红素听力损伤的高危因素之一。ABR与DPOAE联合应用对早期评估高胆红素血症新生儿听力损伤比单独应用更准确。

Objective Study the characteristics of hearing injury following neonatal hyperbilirubinemia by examining distortion product otoscoustic emissions（DPOAE）and auditory brainstem response（ABR）.Methods One hundred and five term newborns with hyperbillirubinemia underwent DPOAE,inculding 17 newbrons with acute bilirubin encephalopathy（ABE）who underwent ABR and DPOAE.According to the level of bilirubin,all newborns were divided into 3 groups.The newborns whose bilirubin concentration exceeded 256 μmol/L were divided into hemolysis group and no hemolysis group.Results In the newborns with hyperbilirubinemia,abnormal rate of DPOAE was 33.7%.The abnormal rate of DPOAE was increased with the increase of serum bilirubin concentration.The hearing injury could gradually recover.The abnormal rate of DPOAE with hemolysis was higher than that of DPOAE without hemolysis.There was no apparent difference of abnormal rate between ABR and DPOAE in the group with ABE.Conclusions Hyperbilirubinemia can cause the abnormal function of cochlea.Hemolysis was the risk factor of hearing injury caused by hyperbilirubinemia.The combination of ABR and DPOAE in hearing screening of neonates with hyperbilirubinemia is more accurate and sensitive than either method alone.