脑干听觉诱发电位对重症手足口病患儿脑损伤的评价

目的 探讨脑干听觉诱发电位（BAEP）对重症和危重症手足口病患儿脑损伤的评价作用。方法 以2010年8月至2011年12月在广州市妇女儿童医疗中心住院治疗的重症和危重症手足口病患儿作为重症组和危重症组，于入院时和病程2周时行BAEP检查，以同期住院的无神经系统受损表现的手足口病患儿为对照组，于入院时行BAEP检查。比较3组BAEP各项指标间的差异。采用脑干反应阈值及Hall分级法比较治疗前后BAEP的变化情况。结果 重症组121例，危重症组102例，对照组200例进入分析。①对照组未见BAEP异常病例，重症组34例(28.1%)BAEP异常，危重症组49例(48.0%)BAEP异常，差异有统计学意义（P<0.05）。BAEP Ⅲ波PL延长、Ⅲ或Ⅴ波波幅低平或分化不良的发生率危重症组显著高于重症组（P<0.05）。②重症组和危重症组脑干反应阈值在治疗后较治疗前均显著降低（P<0.05）。治疗前危重症组脑干反应阈值显著高于重症组（P<0.05），治疗后两组差异不显著。重症组和危重症组治疗后BAEP 1级所占比例均较治疗前显著增加，2和3级比例均有下降。结论 重症和危重症手足口病患儿均存在脑干功能损伤，以脑干反应阈值升高、Ⅲ波PL延长、Ⅲ波和Ⅴ波波幅低平或分化不良为主。Hall分级法和脑干反应阈值可动态评估BAEP变化，推测病情可能的演变。

Evaluation of brainstem auditory evoked potential in assessment of brain impairment ot children with severe hand-foot-mouth disease

Objective To investigate the value of brainstem auditory evoked potential for assessment of brain impairment of children with severe hand-foot-mouth disease （HFMD）. Methods Patients with HFMD treated in Guangzhou Women and Children Medical Center from August 2010 to December 2012, were recruited and divided into severe illness group and intensive care group according to their status. Patients with HFMD but with no neurological involvement in hospital at the same time were defined as the control group. Brainstem auditory evoked potential was measured on the day of admission for all patients and the fourteenth clay after onset for severe illness group and intensive care group. The change of brainstem auditory evoked potential was examined and evaluated by the reaction threshold and Hall~ grading. F test andx2 test were performed using SPSS 17.0. Results Four hundred and twenty-three cases with HFMD were enrolled into the study including 121 cases in the sever illness group, 102 cases in the intensive care group and 200 cases in the control group. Brainstem auditory evoked potential examination identified 34 abnormal patients in the sever illness group, 49 in the intensive care group, none of abnormal cases in the control group. The increased reaction threshold value of brainstem, the delayed peak latencies （PL） of wave m, the decreased wave amplitude of m or V wave, were significantly different among the three groups. The reaction threshold value of brainstem and Hall grading were evidently decreased in the severe illness group and intensive care group after treatment. Conclusion In the brainstem impairment due to HFMD, brainstem auditory evoked potential showed mainly the increased reaction threshold value of brainstem, the delayed peak latencies （PL） of wave HI, the decreased wave amplitude of or V wave. The reaction threshold value of brainstem and Hall grading can be used to evaluating the change of brainstem auditory evoked potential, it is helpful to assess the progress of brainstem impairment of the children with HFMD.