早产低出生体重儿听觉功能评估及临床特征分析  

Evaluation and analysis of auditory function and its clinical characteristics in low birth weight premature infants

作　　者：罗仁忠[1] 王小亚[1] 温瑞金[1] 周佳霖[1] 梁剑[2] 黄振云[1] 高胜利[1] 陈倩[1] 

机构地区：[1]广州市妇女儿童医疗中心广州市儿童医院耳鼻咽喉科,510120 [2]广东省疾病预防控制中心

出　　处：《中华耳鼻咽喉头颈外科杂志》2009年第11期893-899,共7页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：广州市科技攻关计划重大项目（200521-E0105）;广东省科技厅社会发展计划项目（83088）

摘　　要：目的本研究对孕龄〈37周的早产儿，按其不同的出生体重进行分组，对其听力状况进行动态观察和分析，探讨早产低出生体重儿的听力异常状况及婴幼儿早期听觉功能发育的规律。方法选取2004年1月至2008年2月孕龄〈37周并进行听力评估者，共252例（504耳）。根据入选早产儿的出生体重大小分为：出生体重≤1．50kg、1．51～2．00kg、2．01～2．50kg以及〉2．50kg四组。每个出生体重组又根据受试者首次接受听力评估时的月龄大小，分为0～3月龄（包含3个月）、3～6月龄（包含6个月）和〉6月龄三个亚组；对于同一研究对象在不同月龄时曾接受多次听力评估者，再设多次评估亚组。所有患儿均进行～项或是多项客观听力检测，包括听性脑干反应（ABR）、畸变产物耳声发射（DPOAE）、鼓室声导抗和镫骨肌声反射。结果随着早产儿出生体重的增加，ABR波V阈值存在降低的趋势，ABR波V阈值（正常听力级）≤40dB耳的比例也逐渐增加。随着早产儿出生后月龄的增加，ABR波V阈值也存在降低的趋势，ABR波V阈值≤40dB耳的比例逐渐增加。多次评估组中，各出生体重组的ABR总好转率，最低者为56．67％；出生体重≤1．50kg组耳重复评估间隔时间〈2月的ABR好转率，明显高于出生体重1．51～2．00kg组和2．01—2．50kg组；1．51—2．00kg组重复评估间隔时间〈2月时，测试耳ABR的好转率明显低于间隔时间为2～3月和〉3月的好转率。有4例6耳ABR表现为最大强度刺激声（正常听力级103dB）无波分化或仅见波V，而DPOAE各频点幅值却均在正常范围内，初步诊断为听神经病，其发生率为3．75％（6耳／160耳）。结论早产低出生体重儿的听觉功能（包括中耳及听觉神经系统），随出生体重及出生后月龄的增加，在一定时段存在逐渐发育完善的现象。对于听力评估异常的早产低出生体重儿Objective To investigate and analyze dynamic changes of auditory function in premature babies with fetal age of less than 37 weeks who were categorized into different birth weight groups and to detect abnormalities of auditory function in these babies and to describe the early development patterns of auditory function in infancy. Methods Total of 252 subjects （504 ears） from neonatal ward, neonatal intensive care unit and auditory clinic in Guangzhou Children Hospital, whose fetal age were less than 37 weeks, were included in our study and received auditory function evaluation from January 2004 to February 2008. To investigate the correlation between birth weight and development and abnormality of auditory function in premature babies, all subjects were divided into four groups according to birth weight： ≤ 1.50 kg, 1.51 -2. 00 kg, 2. 01 -2. 50 kg and 〉 2. 5 kg. Each group was further categorized by subject＇s age on first auditory function evaluation in 0 - 3 months （ include 3 months）, 3 - 6 months （ include 6 months） and above 6 months, respectively. Subjects who were evaluated more than once in different age frame would be grouped into multiple evaluation subgroups. All subjects underwent one or more objective auditory examinations including auditory brainstem response （ABR）, distortion product otoacoustic emission （DPOAE）, tympauometry and acoustic stapedius reflex. Results A tendency of decreased wave V threshold of ABR was seen as birth weight increased, while the percentage of subjects with ABR wave V threshold ≤ 40 dB nHL increased as well. A tendency of decreased wave V threshold of ABR was also seen as age increased after birth, likewise the percentage of subjects with ABR wave V threshold ≤ 40 dB nHL increased with age after birth. For multiple evaluation subgroups, improvement rate ranged from 56. 67% to 82.76% depending on subjects＇ birth weight. In all low birth weight（LBW） premature babies, 4 subjects and 6 ears with no wave or just wave V at maximum stimulation

关 键 词：婴儿 早产 婴儿 出生时低体重 诱发电位 听觉 脑干 听觉障碍 

分 类 号：R686[医药卫生—骨科学]