听性脑干反应在新生儿缺氧缺血性脑病听力损害及预后判断中的应用

Application of auditory brainstem response in hearing impairment and prognosis of neonatal hypoxic ischemic encephalopathy

目的:探讨听性脑干反应在新生儿缺氧缺血性脑病(HIE)的听力损害及预后判断中的应用效果。方法:选取HIE患儿45例,均进行听性脑干反应检测,随访3年,观察患儿预后。结果:45例(90耳)患儿中,77耳(85.6%)出现听力障碍,其中轻度38耳(49.4%)、中度19耳(24.7%)、重度20耳(26.0%),差异有统计学意义(P<0.05)。中度及重度HIE患儿与轻度比较,听力损害程度更严重,差异有统计学意义(χ~2=7.921,P=0.009)。45例患儿中,40例完成了3年随访,听阈≤60dBnHL者预后较≥61dBnHL者更差,差异有统计学意义(P=0.001)。观察分析患儿听性脑干反应的异常表现,其中轻度HIE患儿13例(76.5%)以Ⅰ波PL分化不良或延长为主;中度及重度HIE患儿26例(92.9%)以Ⅲ、Ⅴ波PL延长,Ⅲ~Ⅴ波IPL延长,Ⅰ~Ⅲ波IPL延长,Ⅰ~Ⅴ波PL延长,Ⅰ~Ⅲ/Ⅲ~Ⅴ波IPL延长比值小于1,以及Ⅴ/Ⅰ波幅小于0.5为主。结论:听性脑干反应可有效反映HIE与听力障碍严重程度之间的关系,以及患儿预后与听力障碍严重程度之间的关系,可作为辅助判断HIE听力损害程度及预后情况的有效手段。

Objective:To investigate the effect of auditory brainstem response in hearing impairment and prognosis of neonatal hypoxic ischemic encephalopathy(HIE).Method:Forty-five children with HIE admitted were enrolled.All patients were tested for auditory brainstem response and followed up for 3 years to observe the prognosis of the children.Result:A total of 90 ears were included in 45 children,of which 77 ears had hearing impairment,accounting for 85.6%;38 ears had mild hearing impairment,accounting for 49.4%;19 ears had moderate hearing impairment,accounting for 24.7%;20 ears had severe hearing impairment,accounting for 26.0%;the difference was statistically significant(P<0.05).Children with moderate and severe HIE had better hearing impairment than children with mild HIE.Serious,the difference was statistically significant(χ~2=7.921,P=0.009).A total of 90 ears were included in 45 patients,40 of whom completed 3 years of follow-up.The prognosis of children with hearing threshold≤60 dBnHL was worse than the threshold≥61 dBnHL,and the difference was statistically significant(P=0.001).Abnormal manifestations of auditory brainstem response were mainly in 13 children with mild HIE(76.5%)with poor differentiation or prolongation ofⅠwave PL;26 patients with moderate and severe HIE(92.9%)WithⅢ,Ⅴwave PL extension,Ⅲ-Ⅴwave IPL extension,Ⅰ-Ⅲwave IPL extension,Ⅰ-Ⅴwave PL extension,Ⅰ-Ⅲ/Ⅲ-Ⅴwave IPL wave interval ratio less than 1,andⅤ/Ⅰamplitude less than 0.5.Conclusion:The auditory brainstem response in the hearing impairment and prognosis of HIE can effectively reflect the relationship between the severity of HIE and the severity of hearing impairment,and the relationship between the prognosis of children and the severity of hearing impairment.It can be used as an effective means to help determine the degree of HIE hearing loss and prognosis.