脑性瘫痪伴听力障碍儿童临床及听力学特征分析  

Analysis of clinical and audiological characteristics of children with cerebral palsy and hearing impairment

作　　者：刘芳 裴铮[1] 罗鑫刚[1] 冯洁芬[2] 肖慧媚[1] 张杰[1] 李碧云 LIU Fang;PEI Zheng;LUO Xingang;FENG Jiefen;XIAO Huimei;ZHANG Jie;LI Biyun(Department of Neu-rological Rehabilitation,Guangdong Women and Children Hospital,Guangzhou 511400,China)

机构地区：[1]广东省妇幼保健院神经康复科,广州511400 [2]广东省妇幼保健院耳鼻喉科,广州511400

出　　处：《实用医学杂志》2020年第15期2120-2124,共5页The Journal of Practical Medicine

摘　　要：目的探讨脑性瘫痪(脑瘫)伴听力障碍儿童的临床及听力学特征,为临床早期明确诊断、特异性康复干预提供指导。方法收集整理46例脑瘫伴听力障碍儿童临床资料,对其临床表现、听力学特点、高危因素、诊断、干预效果等进行分析。结果 (1)46例患儿中89.13%Gesell评估发育迟缓,Gesell评估发育迟缓发生率与患儿首诊主诉相一致(P> 0.05)。(2)32.61%患儿共患癫痫,47.83%患儿脑电图异常,两者无显著差异(P> 0.05);脑电图异常率和头颅MR异常率(69.57%)比较差异有统计学意义(P <0.05)。(3)66.30%患儿耳听觉脑干反应(auditory brain stem response,ABR)听阈重度及以上异常,重度及以上听阈异常耳的畸变产物耳声发射(distortion product otoacoustic emissions,DPOAE)、耳蜗微音电位(cochlear microphonics,CM)引出率明显高于中-重度及以下听阈异常耳,差异有统计学意义(P <0.01),OAE和(或)CM引出率最高达58.7%。发病相关高危因素分析中,高胆红素血症95%置信区间为61.23%、87.41%。结论脑瘫伴听力障碍儿童主要表现为运动、言语、认知发育异常,新生儿高胆红素血症是其首位高发因素,听力障碍程度以重度及以上异常为主、类型以听神经病谱系障碍为主,及时Gesell评估、脑电图、尤其头颅MR检查有助于早期明确诊断。在综合康复治疗的同时,结合人工耳蜗植入等听力干预措施可能会取得更好疗效。Objective To explore the clinical and audiological characteristics of children with cerebral palsy and hearing impairment,and provide guidance for early clinical diagnosis and specific rehabilitation intervention.Methods The clinical data of 46 children with cerebral palsy and hearing impairment were collected and analyzed,and their clinical manifestations,audiological characteristics,high-risk factors,diagnosis,and intervention effects were analyzed. Rusults 89.13% of the patients had Gesell’s assessment of stunting.The incidence of Gesell’s assessment of stunting was consistent with the primary complaint(P> 0.05).Epilepsy was found in 32.61%of the patients,and EEG was abnormal in 47.83% of the patients,but there was no significantly statistic difference(P> 0.05).There was a significant difference between the abnormal rate of EEG and the abnormal rate of skull MR 69.57%(P <0.05).66.30% of the patients’ ears had auditory brain stem response(ABR) hearing threshold severity or above,distortion product otoacoustic emissions(DPOAE),cochlear microphonics(CM) was significantly higher than those with moderate to severe hearing threshold abnormal ears,with a significant difference(P <0.01).In the analysis of related high-risk factors,the 95% confidence intervals for hyperbilirubinemia were 61.23% and87.41%.Conclusion Children with cerebral palsy and hearing impairment are mainly manifested as motor,speech,and cognitive developmental abnormalities.Neonatal hyperbilirubinemia is the first high-risk factor.The degree of hearing impairment is mainly severe and above,and the type is mainly of the neurological spectrum disorder.Gesell assessment,electrograms,and especially cranial MR examination are helpful for early diagnosis.In addition to comprehensive rehabilitation treatment,combination with hearing interventions such as cochlear implantation may be possible will achieve better results.

关 键 词：脑性瘫痪 听力障碍 临床 听力学特征 

分 类 号：R742.3[医药卫生—神经病学与精神病学]