新生儿重症监护病房早产儿听力损失的危险因素分析

Analysis of risk factors of premature infants hearing loss in NICU

目的探讨不同胎龄早产儿及多种高危因素与听力损失程度的关系,为临床诊断、治疗提供可靠依据。方法选取2010年1月至2012年6月入住我院NICU的早产儿为观察组,同期按约1∶1的比例选取普通新生儿病房的足月儿为对照组,两组患儿均为双耳瞬态耳声发射（TEOAE）初筛未通过者。应用脑干听觉诱发电位（BAEP）对不同胎龄新生儿进行听力测试,以单耳Ⅴ波反应阈〉65 dBpeSPL（30 dBHL）为听力损失的参考指标,对多种高危因素进行逐步回归分析,并对听力损失患儿进行随访。结果本文共检测123例早产儿和100例足月儿,早产儿听力损失总发生率为66.7%（164/246耳）,其中各胎龄组异常率分别为〈30周100%（12/12耳）,30～34周75.0%（87/116耳）,35～36周55.1%（65/118耳）,足月儿总异常率为39.5%（79/200耳）。早产儿各胎龄组异常率均高于足月儿,差异有统计学意义（P〈0.05）。不同胎龄组之间早产儿BAEP差异有统计学意义（P〈0.05）,表现为胎龄越小,Ⅰ、Ⅲ、Ⅴ波峰潜伏期越延长,而Ⅲ-Ⅴ、Ⅰ-Ⅴ峰间期差异无统计学意义（P〉0.05）。出生胎龄（F=6.254）、高胆红素血症（F=6.925）、宫内感染（F=8.846）、ABO溶血（F=8.000）是早产儿听力损失的独立危险因素（P〈0.05）。随访的76例听力损失早产儿中,42例恢复正常（55.3%）,随访的34例听力损失足月儿中,28例恢复正常（82.4%）。结论 BAEP是一种比较客观评价早产儿听力损失及脑干功能的可行检测技术。造成NICU早产儿听力损失的主要危险因素是胎龄、高胆红素血症、宫内感染和ABO溶血。

Objective To investigate various risk factors and the degree of hearing loss between preterm infants of different gestational ages to provide a reliable basis for clinical diagnosis and treatment in the neonatal intensive care unit（ NICU）. Methods Observation group and control group were selected according to the proportion of about 1∶1 between NICU preterm infants and post neonatal ward full-term infants from 2010 January to 2012 June in our hospital. Both groups of infants did not pass the binaural transient otoacoustic emission（ TEOAE） screening. Brainstem auditory evoked potential（BAEP） was done on all infants. V-wave single-ear response threshold〉 65 dBpeSPL（30 dBHL） was used as a reference index of hearing loss. Stepwise regression analysis was conducted for a variety of risk factors,and to follow the infants with hearing loss. Results A total of 123 preterm infants and 100 fulltime infants were enrolled in the study. Hearing loss occurred in 164 ears（164 /246,66. 7%）,among which,infants of less than 30 weeks had hearing loss in 12 ears（12 /12 ears,100%）,infants of 30 to34 weeks in 87 ears（ 87 /116 ears,75%）,infants of 35 to 36 weeks in 65 ears（ 65 /118 ears,55. 1%）. Hearing loss occurred in 79 ears（ 79 /200,39. 5%） in full-time infants. There were statistically significant differences between preterm infants with BAEP of different fetal age groups（P〈0.05）. The younger gestational ages showed more prolonged Ⅰ,Ⅲ,Ⅴ peak latencies,but no significant Ⅲ-Ⅴ, Ⅰ-V peak interval differences（ P〉0. 05）. Gestational age（ F = 6. 254）,hyperbilirubinemia（F = 6. 925）,intrauterine infection（F = 8. 846）,ABO hemolytic（F = 8. 000） were independent risk factors for hearing loss in preterm infants（P〈0. 05）. 76 cases in preterm infants were followed up. Of these,42 cases returned to normal（55. 3%）. Of 34 cases in full-term infants,28 cases returned to normal（82. 4%）. Conclusions BAEP is an objective detection technology for preterm infant hearing loss and brain function. The main risk factors of NICU preterm infants with hearing loss are gestational age,hyperbilirubinemia,intrauterine infection and ABO hemolysis.