听性脑干反应在新生儿缺氧缺血性脑病的听力损害研究及预后判断中的应用

目的 应用听性脑干反应(ABR)研究新生儿缺氧缺血性脑病(HIE)与患儿听力损害的关系并辅助判断脑病预后.方法 前瞻性收集成都市妇女儿童中心医院新生儿科2006年1月～ 2008年6月住院确诊的HIE患儿,检测患儿的ABR并随访3年观察其预后,分析HIE严重程度与听力障碍严重程度的关系,以及听力障碍严重程度与预后的关系.统计分析采用SPSS 18.0软件,组间率的比较采用x2检验.结果 共纳入40例HIE患儿,80只耳,其中33例完成3年预后随访.结果显示:86.3％的HIE新生儿有听力障碍,以轻度听力障碍为主(40.0％)；中、重度HIE较轻度HIE患儿听力损害更重(连续校正x2=7.383,P=0.007).ABR结果显示:轻度HIE以I波PL延长或分化不良为主,占78.1％；中-重度HIE以Ⅲ、V波PL延长等中枢段异常为主,占95.8％.与听力阈值≤60 dB患儿比较,听力阈值＞60 dB患儿预后更差(Fisher确切概率P=0.001).结论 ABR反映出HIE严重程度与听力损害程度呈正相关,听力损害程度越重的患儿其预后越差,ABR可用于辅助判断新生儿HIE的预后.

Application of Auditory Brainstem Response in the Hearing Loss and Prognosis Research on Neonatal Hypoxic Ischemic Encephalopathy

Objective Application of auditory brainstem response（ABR） in the study on the relationship of neonates with hypoxic-ischemic encephalopathy（HIE） and the children with hearing loss and auxiliary determine the prognosis of encephalopathy.Methods We prospectively selected neonates diagnosed as HIE in the department of neonatology of the Chengdu Women and Children Central Hospital from January,2006 to June,2008.Neonatal ABR was tested and the prognosis of neonates were observed through 3-year followed up in order to analyze the relationship between HIE severity and the severity of hearing handicap and the relationship between the severity of hearing handicap and prognosis.Statistical analysis was performed using SPSS 18.0.χ2test was used to compare the rate between groups.Results 40 cases involving 80 ears were included,of which 33 cases accomplished the 3-year follow-up for prognosis.The results showed that,86.3% HIE neonates had hearing handicap（mainly mild hearing loss,40.0%）.Medium-severe HIE groups had more serious hearing handicap than Mild HIE group with a statistical significance（continuity correction χ2=7.383,P=0.007）.ABR results showed that,mild HIE is mainly manifested as I wave PL prolonged or poorly differentiated,accounting for 78.1%;medium-severe HIE are mainly manifested as III and V wave PL prolonged central segment abnormalities,accounting for 95.8%;the hearing threshold no more than 60 dB group had better prognosis than the hearing threshold more than 60 dB group prognosis（Fisher exact probability P=0.001）.Conclusion ABR reflects that HIE severity and was positively related to the severity of hearing handicap.The more serious hearing loss in neonates is,the worse prognosis the neonates have.ABR can be used to assist the assessment of the prognosis of neonatal HIE.