脑损伤综合征患儿脑干听觉诱发电位临床特点分析

目的 了解脑损伤综合征患儿的听力特点及影响因素, 为早期干预治疗提供依据。方法 选择2017年6月至2018年6月到昆明市儿童医院康复科就诊的脑损伤综合征患儿466例, 所有患儿均行脑干听觉诱发电位 (brainstem auditory evoked potential, BAEP) 检查, 对其中早产儿 (分为34～37周、31～34周、<31周3组) 、缺氧缺血 (分为HIE、非HIE 2组) 、黄疸 (分为核黄疸、非核黄疸2组) 进行统计学分析, 比较不同高危因素之间患儿听力受损率及受损严重程度是否存在差异。结果 检测脑损伤综合征患儿466例共932耳, 异常率为21.0%, 轻度听力受损95耳 (48.5%) , 中度听力受损72耳 (36.7%) , 重度听力受损29耳 (14.8%) 。其中核黄疸组BAEP异常检出率最高, 为51.9%。34～37周、31～34周、<31周3组不同胎龄早产儿组BAEP异常率无统计学差异 (χ2=5.826, P> 0.05) , 但听力损伤程度有统计学差异 (Z=11.837, P <0.01) , 早产孕周越小听力损伤越严重;HIE组与非HIE组比较, BAEP异常率无统计学差异 (χ2=3.66, P> 0.05) , 但2组听力受损程度有统计学差异 (Z=-2.107, P <0.05) , HIE组听力损伤较非HIE组严重;核黄疸组和非核黄疸组BAEP异常率及听力受损程度均有统计学差异 (χ2=22.286, P <0.01;Z=-2.666, P <0.01) , 核黄疸组BAEP异常率较高、听力受损程度较重;核黄疸组和非核黄疸组BAEP异常率及听力受损程度比较均有统计学差异, 核黄疸组BAEP异常率较高、听力受损程度较重 (χ2=22.286, P <0.01;Z=-2.666, P <0.01) 。结论 脑损伤综合征患儿中早产孕周越小、HIE、核黄疸的患儿听力损伤程度较重, 在高胆红素血症的患儿中核黄疸患儿的听力异常率也较非核黄疸患儿高, 因此以上高危因素的患儿应尽早进行BAEP检测, 评估听力情况。

Clinical Characteristics of Brainstem Auditory Evoked Potential in Children with Brain Injury Syndrome

Objective To provide evidences for early intervention in chidren with brain injury syndrome through studing the hearing characteristics and influencing factors in these children. Methods A total of 466 children with brain injury syndrome were selected who visited Kunming children's Hospital from June 2017 to June2018. All children were examined by brainstem auditory evoked potential (BAEP) . The premature infants group (34-37 weeks, 31-34 weeks, < 31 weeks threegroups) , hypoxia group (HIE and non-HIEtwo groups) and jaundice group (nuclear jaundice and non-nuclear jaundice twogroups) were analyzed statistically to compare the difference of hearing impairment rate and severity between different degreeof risk factors.Result The abnormal detection rate of BAEP was the highest in the nuclear jaundice group (51.9%) .There was no significant difference in the abnormal rate of BAEP among three groups of preterm infants of different gestational age (χ2= 5.826, P >0.05) , but there was significant difference in the degree of hearing impairment (Z = 11.837, P < 0.01) .The smaller the gestational age, the more serious the hearing damage. There was no significant difference in the abnormal rate of BAEP between HIE group and non HIE group ( χ2= 3.66, P > 0.05) , but there was significant difference in the degree of hearing impairment (Z =-2.107, P < 0.05) , hearing impairment in HIE group was more serious than that in non-HIE group. The abnormal rate of BAEP and the degree of hearing impairment were significantly different between the nuclear jaundice and non-nuclear jaundice. The abnormal rate of BAEP was higher and the degree of hearing impairment was more serious in the group of nuclear jaundice. (χ2= 22.286, P <0.01, Z =-2.666, P < 0.01) .Conclusions In the children with brain injury syndrome, the smaller the week of premature delivery, HIE and the nuclear jaundice, the more serious degree of hearing impairment. In children with hyper bilirubinemia, the rate of abnormal hearing in nuclear jaundice is higher than that in children without nuclear jaundice. Therefore, BAEP test should be performed as soon as possible to assess the hearing status of children with the above risk factors.