城市流动人口新生儿听力筛查方案探讨  

A Study of Universal Newborn Hearing Screening Protocol in Urban Mobile Population

作　　者：程晓华[1] 黄丽辉[1] 亓贝尔[1] 蔡正华[1] 彭士春[1] 恩晖[1] 甄勇[1] 吴雅琴 王天成 

机构地区：[1]首都医科大学附属北京同仁医院北京市耳鼻咽喉科研究所耳鼻咽喉头颈科学教育部重点实验室(首都医科大学),北京100005 [2]北京市上地医院

出　　处：《听力学及言语疾病杂志》2011年第2期120-122,共3页Journal of Audiology and Speech Pathology

基　　金：国家"十五"科技攻关项目(2004BA720A18-02);国家"十一五"科技支撑计划(2007BAI18B12);国家卫生部面向农村和基层推广适宜技术十年百项计划推广项目(卫通[2006]14号)联合资助

摘　　要：目的探讨适合城市流动人口的新生儿听力普遍筛查方案。方法应用瞬态诱发性耳声发射（TEOAE）对北京市上地医院出生的5 484名新生儿进行听力筛查,采用＂两步初筛＋两步复筛＂方案,即初筛未通过者出院前再筛查一次,1月龄复筛未通过者于2月龄时再复筛一次,仍未通过者于3月龄内转诊至儿童听力诊断中心进行听力学诊断和医学评估。结果 2009年4~12月北京市上地医院应筛查5 538人,实际接受初筛5484人,初筛覆盖率99.02%（5484/5538）,其中外地户籍新生儿5368人,占筛查人数的97.88%（5368/5484）。初筛未通过1498人,未通过率27.32%（1498/5484）;1498人中出院前接受二次筛查858人,通过511人,未通过347人。经过两次院内初筛后最终未通过987人（1498-511）,未通过率18.00%（987/5484）。1月龄时实际复筛587人,复筛率59.47%（587/987）,通过472人,未通过115人,转诊率为2.10%（115/5484）;2月龄时实际复筛69人,复筛率60%（69/115）,通过26人,未通过43人,最终转诊率为0.78%（43/5484）。首次初筛和二次初筛后的未通过率,以及一次复筛和二次复筛后的转诊率比较,差异有统计学意义（P〈0.01）。实际接受听力诊断26人,确诊听力损失16人（19耳）,其中双耳轻度3人,单耳轻度10人,单耳极重度3人,听力损失的检出率为2.92‰（16/5484）。结论在城市流动人口中采用＂两步初筛＋两步复筛＂方案进行新生儿听力普遍筛查,可有效提高初筛覆盖率,降低初筛未通过率和转诊率,是一种行之有效的筛查方案。Objective To explore a feasible protocol for carrying universal newborn hearing screening in urban mobile population.Methods A two-stage hearing screening protocol consisted of a two-step inpatient screening and two-step outpatient rescreening performed by TEOAE.Newborns who failed the first screening underwent a rescreening before hospital discharge.Infants referred from the inpatient screening underwent an outpatient rescreening at 1 month of age,and those who failed this outpatient rescreening were required to have another rescreening at 2 months of age.Those who failed both screenings would receive a comprehensive audiological evaluation at 3 months of age.Results From April 2009 to December 2009 in Beijing Shangdi Hospital,a total of 5 538 newborns were available for screening,and 5 484 were screened（99.02%） before hospital discharge.1 498 of them（27.32%） failed the first inpatient screening and 858 of them were received a second screening before hospital discharge with 511 passed.A total of 987（18%） failed after the second inpatient screening.587 infants（59.47%） were rescreened at 1 month old,and 115 of them failed with the referral rate at 2.10%（1 15/5 484）.69 infants（60%） were rescreened at 2 months old,and 43 of them failed with the referral rate at 0.78%（43/5 484）.Conclusion Two-step inpatient screening with two-step outpatient rescreening protocol can effectively improve the coverage rate and reduce the referral rate,which is an effective hearing screening protocol in urban floating population.

关 键 词：新生儿 听力筛查 筛查方案 流动人口 

分 类 号：R764.04[医药卫生—耳鼻咽喉科]