不同程度高胆红素血症患儿脑干听觉诱发电位及神经行为的预后研究  

Prognosis of Brainstorm Auditory Evoked Potential and Neurobehavior in Newborns With Different Level of Hyperbilirubinemia

作　　者：王乐[1] 傅燕娜[1] 郑洪[1] 张健[1] 芦玮玮[1] 

机构地区：[1]安徽医科大学附属儿科临床学院新生儿内科,安徽省合肥市230000

出　　处：《中国全科医学》2015年第20期2413-2417,共5页Chinese General Practice

基　　金：安徽省卫生厅科研项目(2010C086)

摘　　要：目的探讨新生儿期不同程度高胆红素血症对患儿听力及神经行为的影响。方法选取2013年6月—2013年12月于安徽医科大学附属儿科临床学院新生儿内科收治的高胆红素血症足月新生儿105例为研究对象,按总胆红素（TSB）水平分为轻度黄疸组（TSB为221.0~341.9μmol/L,39例）、中度黄疸组（TSB为342.0~427.5μmol/L,35例）和重度黄疸组（TSB〉427.5μmol/L,31例）。患儿治疗后TSB水平降至85.0μmol/L以下时进行脑干听觉诱发电位（BAEP）检测和20项新生儿神经行为测定（NBNA）,3月龄时复查NBNA并进行52项神经行为测定。结果3组患儿新生儿期Ⅰ波、Ⅲ波、Ⅴ波潜伏期（PL）和Ⅲ~Ⅴ波、Ⅰ~Ⅴ波峰间期（IPL）比较,差异有统计学意义（P〈0.05）;其中,重度黄疸组Ⅰ波、Ⅲ波、Ⅴ波PL和Ⅲ~Ⅴ波、Ⅰ~Ⅴ波IPL较轻度黄疸组和中度黄疸组长,差异有统计学意义（P〈0.05）。各组轻、中度BAEP异常主要表现为Ⅰ、Ⅲ、Ⅴ波PL延长,重度BAEP异常主要表现为波形缺失。轻度黄疸组BAEP异常8例（20.5%）,中度黄疸组中BAEP异常15例（42.9%）,重度黄疸组BAEP异常25例（80.6%）,3组BAEP异常率比较,差异有统计学意义（χ2=25.338,P〈0.01）。3组患儿3月龄时Ⅲ波PL比较,差异有统计学意义（P〈0.05）,其中,重度黄疸组Ⅲ波PL较轻度黄疸组和中度黄疸组长,差异有统计学意义（P〈0.05）。各组轻、中度BAEP异常主要表现为Ⅰ、Ⅲ、Ⅴ波PL延长,重度BAEP异常主要表现为波形缺失。轻度黄疸组中BAEP异常2例（5.1%）,中度黄疸组中BAEP异常5例（14.3%）,重度黄疸组BAEP异常18例（58.1%）,3组BAEP异常率比较,差异有统计学意义（χ2=25.305,P〈0.01）。3组患儿新生儿期NBNA评分比较,差异有统计学意义（P〈0.05）,其中重度黄疸组NBNA评分低于轻、中度黄疸组,差异有统计学意义（P〈0.05）。52项神经行为测定结果显示,轻度黄疸组神经行为异常9例（23.1Objective To investigate the influence of different level of hyperbilirubinemia on audition and neurobehavior in neonatal period.Methods We enrolled 105 full-term infants with hyperbilirubinemia that were admitted into Department of Neonatology,Institute of Clinical Pediatrics,Anhui Medical University from June,2013 to December,2013.According to the level of Total Serum Bilirubin（TSB）,the included newborns were divided into mild jaundice group（TSB：221.0-341.9 μmol/L,n = 39）,moderate jaundice group（TSB：342.0-427.5 μmol/L,n = 35） and severe jaundice group（TSB 427.5 μmol/L,n = 31）.When the TSB level dropped to 85.0 μmol/L after treatment,brainstorm auditory evoked potential（BAEP） and 20 items of neonatal behavioral neurological assessment（NBNA） were tested.When the newborns were three-month old,NBNA was reexamined and another 52 items of neurobehavior were tested.Results During neonatal period,the three groups were significantly different in peak latencies（PL） of WaveⅠ,Ⅲ,Ⅴ and in interpeak latency（IPL） of waveⅢ-Ⅴ and waveⅠ-Ⅴ（P 0.05）; PL of Wave I,Ⅲ,Ⅴ and IPL of Wave Ⅲ-Ⅴ and WaveⅠ-Ⅴ in severe jaundice group were significantly longer than those of mild jaundice group and moderate jaundice group（P 0.05）.The mild and moderate abnormity of BAEP was mainly manifested as prolonging in PL of Wave Ⅰ,Ⅲ,Ⅴ,and severe abnormity of BAEP was mainly manifested as the missing of waveform.The number of infants with abnormal BAEP was 8（20.5%） in mild jaundice group,15（42.9%） in moderate jaundice group and 25（80.6%） in severe jaundice group; the differences in the BAEP abnormality rate among the three groups were significant（χ2= 25.338,P 0.01）.When the newborns were three-month old,the three groups were significantly different in PL of Wave Ⅲ（P 0.05）; severe jaundice group had longer PL of Wave Ⅲthan mild and moderate jaundice groups（P 0.05）.The mild and moderate abnormity of BAEP was mainly manifested as prolonging in PL of Wav

关 键 词：高胆红素血症 新生儿 诱发电位 听觉 脑干 神经行为学表现 

分 类 号：R722.17[医药卫生—儿科]