窄带CE-chirp和短纯音听性脑干反应(ABR)在早产儿听力评估中的应用比较

Auditory Brain Stem Responses(ABRs)to Narrow Band CE-chirp and Tone Burst in Premature Infants

目的比较早产儿窄带CE-chirp(NB CE-chirp)和短纯音(Tone Burst,TB)听性脑干反应(ABR)的特征。方法对78例早产儿(107耳)进行NB CE-chirp和TB ABR 500、1000Hz检测分析,比较电反应阈、潜伏期、振幅特征。结果500和1000Hz NB CE-chirp ABR反应阈低于TB ABR(P=0.000,P<0.01),500Hz的NB CE-chirp和TB ABR反应阈为28.49±6.18dB nHL和37.26±5.82dB nHL,差值为8.77dB;1000Hz的NB CE-chirp和TB ABR反应阈分别为19.02±6.27dB nHL和26.50±7.75dB nHL,差值为7.48dB。NB CE-chirp ABR阈值V波潜伏期均明显短于TB ABR(P=0.000,P<0.01),500Hz NB CE-chirp和TB ABR阈值V波潜伏期分别为8.73±0.96ms和13.92±0.90ms,1000Hz NB CE-chirp和TB ABR阈值V波潜伏期分别为8.51±0.72ms和12.00±0.87ms。在40 dB nHL,500和1000Hz NB CE-chirp ABR的V波振幅为0.21±0.09μV和0.29±0.12μV,显著大于TB ABR的0.17±0.06μV和0.21±0.10μV(P=0.000,P<0.01)。在阈值强度,NB CE-chirp和TB ABR的阈值V波振幅差异无显著性(P=0.256,P=0.166)。结论在500和1000Hz,NB CE-chirp ABR更接近行为听阈,波幅更大,不同频率潜伏期更相近。Click ABR结合500和1000Hz NB CE-chirp ABR能更全面、准确地评估早产婴幼儿的听力特征。

Objective To report characteristics of ABRs to narrow band CE-chirp and tone burst stimuli in premature infants.Methods Thresholds,latencies and amplitudes of narrow band CE-chirp and tone burst ABRs at 500 and 1000 Hz were recorded in78 premature infants(107 ears).Results Thresholds of NB CE-chirp ABRs were lower than TB ABRs at both 500 and 1000 Hz(P=0.000,P<0.01).Thresholds of NB CE-chirp and TB ABRs were 28.49±6.18 and 37.26±5.82 dB nHL,respectively,at 500 Hz,and 19.02±6.27 and 26.50±7.75 dB nHL,respectively,at 1000 Hz.Wave V latencies of tone burst ABRs were greater than those of narrow band CE-chirp ABRs at both 500 and 1000 Hz(P=0.000,P<0.01).The latencies of NB CE-chirp and TB ABRs were 8.73±0.96 and 13.92±0.90 ms,respectively,at 500 Hz,and 8.51±0.72 and 12.00±0.87 ms,respectively,at 1000 Hz.At 40 dB nHL,the amplitudes of NB CE-chirp ABRs at both 500 and 1000 Hz(0.21±0.09μV and 0.29±0.12μV,respectively)were greater than those of TB ABRs(0.17±0.06μV and 0.21±0.10μV,respectively)(P=0.000,P<0.01).Wave V amplitudes at threshold(0.13-0.14μV)were not significantly different between NB CE-chirp and TB ABRs(P=0.256,P=0.166).Conclusion At 500 and 1000 Hz,NB CE-chirp ABR thresholds are more consistent with subjective hearing threshold than TB ABRs,with greater amplitudes and more similar latencies at different frequencies.Combining NB CE-chirp ABRs at 500 and 1000 Hz with click ABRs can provide more comprehensive and accurate auditory evaluation in premature infants.