应用脑干听觉诱发电位监测早产儿胆红素神经损害的意义  

Application of Brainstem Auditor Evoked Potential for Evaluating Bilirubin Nerval Toxicity in Preterm Infants

作　　者：吕回[1] 罗慧[1] 赵宁[1] 黄晓虹[1] 李耘[1] 赖剑蒲[1] 陆玲[1] 

机构地区：[1]广州市儿童医院新生儿科,广东广州510120

出　　处：《中国误诊学杂志》2005年第5期807-809,共3页Chinese Journal of Misdiagnostics

摘　　要：目的:探讨早产儿血清胆红素(SB)增高时导致神经系统损害时其SB临界值,以及影响临界值的高危因素。方法:收集2 0 0 0 - 0 1～2 0 0 2 - 12在我院新生儿科住院并出现黄疸的早产儿共16 7例,以脑干听觉诱发电位(BAEP)出现异常作为神经损害标志。入院后即检测SB浓度及BAEP,当出现皮肤黄疸后每日检测SB浓度及BAEP1次,直至BAEP出现异常,并记录出现异常时对应的SB值。同时记录各患儿的胎龄、出生体重、血清白蛋白值和血p H值。结果:本组早产儿引起BAEP异常时,血清间接胆红素(SIB)平均临界值为(177.4 1±2 7.2 3) μmol/ L。而出生胎龄越小,其临界值越低,出生胎龄<32周、～34周、～36 + 6周组的早产儿,其导致BAEP异常时,SIB平均临界值分别为(15 4 .6 7±2 8.92 ) μmol/L、(16 1.6 1±16 .0 6 ) μmol/ L和(173.76±19.2 2 ) μmol/ L。相关分析研究提示出生胎龄、出生体重、血清白蛋白浓度及血p H值均分别与SIB临界值有相关性,P值均<0 .0 0 1。结论:早产儿导致神经损害的SB水平明显低于传统的病理性黄疸水平。在判断影响SB对中枢神经细胞毒性的高危因素时,应重视出生体重、血清白蛋白浓度及血p H值水平。Objective:To explore the critical value of serum bilirubin impairing center nerve cell, and factors affecting critical value of serum bilirubin(SB).Methods:167 cases of preterm infants with jaundice were admitted in our hospital between Jan. 2000 and Dec. 2002.The concentration of SB was assayed and BAEP was detected once every day untill the patient′s BAEP was bacame abnormal, the value of SB was recorded, meanwhile, gestation age, birth weight, concentration of serum albumin and pH were recorded.Results:For the whole cohort,the critical value of total SB was (189.36±24.29) μmol/L, the critical value of serum indirect bilirubin (SIB) was (177.41±27.23) μmol/L. For these infants whose birth gestation age was less than 32 weeks,~34 weeks,~<37 weeks, the high-risky-value of SIB to nerval toxicity were (154.67±28.92) μmol/L、(161.61±16.06) μmol/L and(173.76±19.22) μmol/L respectivley.the high-risky-value of SIB to nerval toxicity were significantly correlative respectively with birth gestation age, birth weight, concentration of serum albumin and blood pH (all P<0.001).Conclusions:the high-risky-value of SIB to nerval toxicity in preterm infants was lower distinctive than that of conventional guideline.birth gestation age, birth weight, concentration of serum albumin and blood pH affected the he high-risky-value of SIB to nerval toxicity.

关 键 词：核黄疸/诊断 诱发电位 听觉 脑干 

分 类 号：R722.604[医药卫生—儿科]