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目的探讨脑干听觉诱发电位在新生儿高胆红素血症中的变化,为胆红素脑病的早期诊断及预后提供客观依据。方法将2005年1月至2007年1月遵义医学院第一附院新生儿科收治的100例高胆红素血症足月新生儿分为两组:重度黄疸组(40例)和轻度黄疸组(60例)。以同期该院产科出生的正常足月新生儿50名为对照组。三组均进行脑干听觉诱发电位(BAEP)检测,对异常者进行随访复查。结果(1)与对照组比较,两组黄疸组的BAEP异常率明显增高(P<0.05),主要表现为各波PL及IPL较对照组延长,和(或)出现波形分化不清,波形缺失;轻、重度黄疸组间的BAEP异常率无明显差异(P>0.05);轻、重度黄疸组间BAEP异常程度的分布的差异有统计学意义(P<0.05);(2)两组黄疸消退后BAEP均有好转,表现为各波PL及IPL均较前缩短(P<0.05),异常率降低(P<0.05);黄疸消退后轻、重度黄疸组之间异常率差异有统计学意义(P<0.05)。随访显示,首次BAEP异常的53例患儿中,46例转为正常,7例BAEP持续异常者均伴有神经系统后遗症。结论(1)BAEP异常是新生儿胆红素脑病的重要特征;(2)足月黄疸儿血清总胆红素(TSB)>221μmol/L时,BAEP即可有改变,提示脑损伤发生,是早期诊断胆红素脑病的重要客观指标;(3)BAEP持续异常提示预后不良。
Objective To explore the changes of brainstem auditory evoked potentials in neonatal hyperbilirubinemia and provide an objective basis for the early diagnosis and prognosis of bilirubin encephalopathy. Methods One hundred newborn infants with full-bilirubin were enrolled in the neonatology department of the First Affiliated Hospital of Zunyi Medical College from January 2005 to January 2007, and were divided into two groups: severe jaundice group (40 cases) and mild jaundice Group (60 cases). The same period the hospital obstetric birth of normal full-term newborn 50 as control group. Three groups were detected brainstem auditory evoked potentials (BAEP), the abnormalities were followed up for review. Results (1) Compared with the control group, the abnormal rate of BAEP was significantly increased in both groups (P <0.05). The main manifestations were as follows: prolongation of PL and IPL in each group and / or worsening of waveform differentiation and waveform deletion (P> 0.05). There was no significant difference in the abnormal BAEP between mild and severe jaundice (P> 0.05). There was significant difference in the distribution of abnormal BAEP among mild and severe jaundice (P <0.05). (2) After BAEP were improved, the performance of the wave PL and IPL were shortened compared with the previous (P <0.05), the abnormal rate decreased (P <0.05); jaundice subsided mild and severe jaundice after the difference between the rates were statistically significant ( P <0.05). Follow-up showed that among the 53 children with the first abnormal BAEP, 46 were normal, and 7 patients with abnormal BAEP were accompanied by neurological sequelae. Conclusions (1) BAEP abnormalities are important features of neonatal bilirubin encephalopathy. (2) Serum total bilirubin (TSB)> 221μmol / L of full-term jaundice can change BAEP, suggesting that brain injury is Early diagnosis of bilirubin encephalopathy important objective indicators; (3) BAEP persistent abnormalities suggest a poor prognosis.