84例母体产前应用地塞米松新生儿畸变产物耳声发射结果初步分析

The Effects of Maternal Prenatal Administration of Dexamethasone on Distortion Product Otoacoustic Emission Results of 84 Newborns

目的通过对母体产前应用地塞米松的新生儿畸变产物耳声发射（DPOAE）结果的分析，探讨地塞米松对新生儿听觉系统的影响。方法回顾完成听力初筛的1021例资料完整的新生儿病例资料，记录母儿孕产期因素及DPOAE结果；将产前应用地塞米松的新生儿与未应用地塞米松及其他糖皮质激素的新生儿分别设为观察组与对照组，两组按照性别、胎数、胎龄、出生体重、Apgarl分钟评分、有无新生儿缺氧窒息、先天性听力损失家族史等因素进行1：1配对。采用McNemar检验和配对资料t检验对配对成功的2组共168例DPOAE通过率及各频率反应幅值进行比较。结果①观察组DPOAE右耳通过率为89．29％，左耳通过率为85．71％，双耳通过率为79．76％；对照组右耳、左耳及双耳通过率分别为94．05％、95．23％、91．67％，对照组通过率均高于观察组l两组左耳通过率及双耳通过率差异有统计学意义（P〈0．05）；②左耳在5649Hz处，观察组DPOAE反应幅值较对照组低，差异有统计学意义（P〈0．05）；两组间左耳其余各频率及右耳各频率DPOAE幅值未见显著性差异（P〉0．05）。结论母体产前应用地塞米松新生儿的DPOAE通过率偏低，在部分频率DPOAE反应幅值较低。产前应用糖皮质激素对听觉系统可能产生的不利影响应引起临床注意。

Objective To explore the effects of maternal prenatal administration of dexamethasone on the auditory systems of newborns by analyzing the distortion production otoacoustic emission （DPOAE） results. Methods The clinical data and DPOAE results of 1021 newborns were recorded retrospectively. The newborns were divided into observation group and control group according to whether their mothers were exposed to dexamethasone before delivery. The two groups were 1：1 pair matched according to genders, number of fetus, gestational age, birth weight, Apgar score at 1 rain, neonatal hypoxia and family history of congenital hearing loss. The pass rate and the response amplitude of DPOAE at each frequency were analyzed by McNemar test and paired-samples t-test for the successfully paired 168 cases. Results （1） For the observation group, the pass rates of right, left and both ears were 89.29% , 85.71% and 79.76%, respectively. For the control group, the pass rates of right, left and both ears were 94.05%, 95.23% and 91.67%, significantly higher than those of observation group. （2） The DPOAE amplitudes of the left ears of the observation group were significantly lower than that of control group at 5649 Hz, but no significant difference was found between the two groups in the DPOAE amplitudes at the other frequencies of left ears and all frequencies of right ears. Conclusion For the newborns whose mothers are exposed to dexamethasone before delivery, the DPOAE pass rate is lower and amplitude is smaller at some frequencies. More attention to the possible adverse effects of prenatal administration of glucocorticoids on auditory system is warranted.