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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 explore the relationship between the risk factors and hearing loss in preterm infants of different gestational age and provide a reliable basis for clinical diagnosis and treatment. Methods From January 2010 to June 2012, the premature infants admitted to NICU in our hospital were selected as the observation group. The full-term infants of general neonatal ward were selected as the control group according to the ratio of about 1: 1 in the same period. The two groups of infants were both double Ear Transient Otoacoustic Emissions (TEOAE) Primary screening failed. The brainstem auditory evoked potentials (BAEP) were used to test the hearing of neonates of different gestational ages. The single-ear Ⅴ wave response threshold> 65 dBpeSPL (30 dBHL) was used as a reference index for hearing loss, Children with hearing loss were followed up. Results A total of 123 preterm infants and 100 full term infants were detected. The total incidence of hearing loss in preterm infants was 66.7% (164/246 ears). The abnormal rates in each gestational age group were 100% (12/12 weeks, 12/12 Ears), 75.0% (87/116 ears) in 30-34 weeks, 55.1% (65/118 ears) in 35-36 weeks, and 39.5% (79/200 ears) in term infants. Abnormal rates of each gestational age group were higher than those of full-term children, the difference was statistically significant (P <0.05). There were significant differences in BAEP among different gestational age groups (P <0.05). The smaller the gestational age, the longer the peak of Ⅰ, Ⅲ and Ⅴ peaks, while the difference between Ⅲ-Ⅴ and Ⅰ-Ⅴ peaks was not significant Statistical significance (P> 0.05). The gestational age (F = 6.254), hyperbilirubinemia (F = 6.925), intrauterine infection (F = 8.846) and ABO hemolysis (F = 8.000) were independent risk factors for hearing loss in preterm infants ). Among the 76 children with hearing loss who were followed up, 42 returned to normal (55.3%). Of the 34 children with term hearing loss, 28 returned to normal (82.4%). Conclusions BAEP is a feasible detection technique for objectively evaluating hearing loss and brainstem function in preterm infants. The major risk factors for hearing loss in preterm infants with NICU are gestational age, hyperbilirubinemia, intrauterine infection and ABO hemolysis.