重度高胆红素血症新生儿总胆红素/白蛋白比值及酸中毒与脑干听觉诱发电位异常的关系

Relationship of B/A ratio and acidosis with abnormal brainstem auditory evoked potentials in neonates with severe hyperbilirubinemia

目的探讨重度高胆红素血症新生儿总胆红素/白蛋白比值(B/A比值)、酸中毒与脑干听觉诱发电位(BAEP)异常的关系及其临床意义。方法纳入2008年11月至2009年10月间重度高胆红素血症患儿967例。按照BAEP的结果,分为BAEP正常组(799例)和BAEP异常组(168例)。对B/A比值、酸中毒与BAEP的关系分别进行单因素分析,再根据日龄因素分别进行分层χ2检验。结果单因素分析结果显示,BAEP异常组较BAEP正常组具有更低的pH值和BE值以及更高的B/A比值,差异有统计学意义。分层χ2检验分析结果显示,对于重度高胆红素血症任何日龄组的患儿,当存在酸中毒或当B/A比值>1时,其BAEP异常的发生率均较对照组增高,差异均有统计学意义。结论高B/A比值、酸中毒是重度高胆红素血症患儿发生BAEP异常的危险因素,且对于任何日龄段的患儿均是如此。故对于任何日龄组的重度高胆红素血症患儿,当存在上述危险因素时,应尽快纠正其酸中毒,降低B/A比值,以降低胆红素听力损伤的发生。

Objective To investigate the relationship of bilirubin/albumin （B/A） ratio and acidosis with abnormal brainstem auditory evoked potentials （BAEPs） in neonates with severe hyperbilirubinemia and its clinical significance. Methods A total of 967 neonates with severe hyperbilirubinemia between November 2008 and October 2009 were enrolled in the study. They were divided into two groups according to their BAEPs： normal BAEP group （n = 799 ） and abnormal BAEP group （ n = 168 ）. Univariate analysis and age-stratified Chi-square test were used to determine the relationship of B/A ratio and acidosis with BAEP. Results The univariate analysis showed that the abnormal BAEP group had significantly lower pld and base excess values and a significantly higher B/A ratio compared with the normal BAEP group （ P 〈 O. 05 ）. The age-stratified Chi-square test showed that neonates with acidosis or with a B/A ratio greater than 1.0 had a significantly higher incidence of abnormal BAEPs than those without acidosis or with a B/A ratio less than 1.0 in any age （days） group of neonates with severe hyperbilirubinemia （ P 〈 0.05 ）. Conclusions High B/A ratio and acidosis are the risk factors for abnormal BAEPs in neonates with severe hyperbilirubinemia, which is the case for those in any age group. In order to reduce the incidence of hearing loss in any age group of neonates with severe hyperbilirubinemia, we should correct the acidosis and lower the B/A ratio as soon as possible.