高危兒聽力篩查及隨訪研究①

呂攀攀，董榮芝，劉芳，王娜娜，徐沖鋒，邴衛衛，耿立蒙

高危兒聽力篩查及隨訪研究①

呂攀攀，董榮芝，劉芳，王娜娜，徐沖鋒，邴衛衛，耿立蒙

目的探索高危兒聽力篩查情況及聽力障礙的發生、變化及轉歸。方法2015年3月～2016年3月，采用耳聲發射(OAE)、聽性腦干反應(ABR)及腦干聽覺誘發電位(BAEP)的方法，對336例高危兒分別于生后0～1、3、6、12個月進行聽力監測。結果336例高危兒中，0～1個月內初檢時29例未通過；3月齡復檢時37例聽力未通過；6月齡27例恢復正常；12月齡復檢7例恢復正常，3例(0.89%)確診耳聾。結論OAE、ABR結合BAEP檢查高危兒聽力損傷可獲得較全面的診斷，連續聽力監測可有效動態觀察高危兒聽力損傷的發生、變化及轉歸。

高危兒；聽力篩查；耳聲發射；聽性腦干反應；腦干聽覺誘發電位；隨訪

[本文著錄格式]呂攀攀，董榮芝，劉芳，等.高危兒聽力篩查及隨訪研究[J].中國康復理論與實踐,2016,22(12):1459-1461.

CITED AS:LüPP,Dong RZ,Liu F,etal.Hearing screening and follow-up of high risk infant[J].Zhongguo Kangfu Lilun Yu Shijian, 2016,22(12):1459-1461.

新生兒及嬰幼兒聽力篩查在許多發達國家已成為常規制度[1-2]，在我國發達地區也已列入常規。新生兒及嬰幼兒聽力篩查，特別是高危新生兒的聽力追蹤評估非常重要。國內外報道均顯示，高危新生兒聽力障礙的發生率為2%～4%，遠高于正常新生兒，是聽力損傷的高發人群[3-5]。高危兒聽力障礙既可能是疾病本身所造成，也可能是由于出生后治療引起。為探索本院就診高危兒聽力損傷情況，我們對2015年3月～2016年3月本院新生兒科及產科出院的高危新生兒進行連續聽力監測，以進一步了解高危兒聽力障礙的發生、變化及轉歸情況。

1 資料與方法

1.1 一般資料

收集本院新生兒科及產科2015年3月～2016年3月出院的新生兒，符合下列指征之一者均為監測對象：羊水異常；胎盤異常；妊娠期高血壓；妊娠期糖尿病；足月小樣兒；早產；低出生體質量；過期產；新生兒高膽紅素血癥；新生兒黃疸；新生兒缺氧缺血性腦病，符合韓玉昆等新生兒缺氧缺血性腦病診斷分度標準[6]；新生兒肺炎。排除標準：先天性并發癥；先天性畸形；其母孕期耳毒性藥物使用史及肝腎疾病史；耳聾及其他遺傳性疾病家庭史。符合指征作為檢測對象的高危新生兒共336例。

1.2 方法

檢查在聽力篩查室由專門人員進行，采用耳聲發射(otoacoustic em issions,OAE)、聽性腦干反應(auditory brainstem response,AABR)及腦干聽覺誘發電位(brainstem auditory evoked potential,BAEP)三種方法。OAE采用CD-RW Vser Cuide測定儀(丹麥)，AABR使用MB11快速聽性腦干反應測試儀(德國MAIKO)。BAEP使用丹迪全功能肌電誘發電位儀KEYPOINT(丹麥)。OAE用于出生后1個月內聽力初篩，AABR用于復查，BAEP用于聽力障礙患兒確診。所有高危兒均在生后0～1、3、6、12個月各聽力測查1次。

1.3 統計學分析

應用M icrosoft Excel2000進行數據錄入和統計學分析。

2 結果

336例(672耳)1個月內篩查未通過者34耳，初篩未通過率5.06%，其中雙耳未通過5例，未通過率1.49%。3個月AABR復查未通過者50耳，復查未通過率7.44%，其中雙耳未通過13例，未通過率3.87%。6個月復查AABR和BAEP未通過者14耳，復查未通過率2.08%，其中雙耳未通過4例，未通過率1.19%。12個月AABR和BAEP復查雙耳未通過者3例，復查未通過率0.89%。說明本研究中聽力損傷兒6個月后恢復正常，0.89%確診耳聾患兒，轉為耳鼻喉診治。見表1。

表1 高危兒聽力篩查情況(n)

回顧分析高危因素，最后確診聽力障礙患兒3例中，1例為新生兒缺氧缺血性腦病，1例為早產低出生體質量，1例為高膽紅素血癥。

3 討論

聽力障礙是常見的出生缺陷。據國內外報道，高危新生兒聽力障礙的發生率遠高于正常新生兒[3-5]。正常新生兒中雙側聽力障礙的發生率約0.1%～0.3%[7-8]。高危新生兒的聽力障礙可能由宮內感染、低出生體質量、窒息、缺氧缺血性腦損傷、肺部疾病、顱內出血、高膽紅素血癥等疾病引起[9-11]，特別是早產兒[12]。也存在遺傳因素[13]。各種高危因素導致高危兒的聽力損失多為中樞性的[14]，臨床上應用OAE、AABR及其他相關專業的檢查如BAEP可以確診[15-17]，大部分損傷是可逆的[18-19]。但是有部分高危新生兒聽力損傷具有獲得性或進展性的特點，遲發型聽力損傷的發病年齡最早可出現在8～12個月[20]，最晚為4～5歲及以后[21-22]，故對該人群聽力進行定期聽力監測和隨訪，顯得尤為重要[23-24]。

國內報道正常新生兒聽力障礙發生率為0.3%；經重癥監護病房搶救的新生兒，聽力障礙發生率高達22.6%[25]。本組高危兒最后確診耳聾3例，發生率為0.89%，顯示高危兒聽力障礙發生率比正常新生兒高，但其聽力損傷多為可逆性，故其最終耳聾發生率與正常新生兒基本一致。

本研究表明，應用OAE初篩有部分高危兒漏診，復檢采用AABR監測為陽性，進一步采用BAEP確診，故采用OAE、AABR和BAEP可獲得較全面的診斷。對出生時通過篩查的高危兒應提高警惕，因為他們亦有可能發生遲發性或獲得性聽力損傷，所以連續的聽力檢測尤為重要[26-27]。

及時發現，早期干預，可以改善患兒聽力，刺激言語功能的發育，最終達到減少聾啞發病率的目的[28-30]。

高危兒聽力損傷后有一段恢復期，不要過早下結論，造成家長思想負擔過重，因為部分高危兒可恢復正常。本研究結果表明，通過實行聽力監測可有效動態觀察到高危兒聽力障礙的發生、變化及轉歸，同時使有聽力障礙高危兒及早得到干預，有效得到康復治療，故建議在建立新生兒聽力篩查同時，對高危兒要實施聽力監測。

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Hearing Screening and Follow-up of High Risk Infant

LüPan-pan,DONGRong-zhi,LIU Fang,WANGNa-na,XU Chong-feng,BINGWei-wei,GENG Li-meng
Departmentof Pediatrics,TheA ffiliated Hospitalof Binzhou MedicalUniversity,Binzhou,Shandong 256603,China

ObjectiveTo explore the hearing screening,and the change and outcome of hearing impairmentof high risk infants.MethodsFrom March,2015 to March,2016,336 high risk infantswere screened w ith otoacoustic emissions(OAE),auditory brainstem response (ABR)and brainstem auditory evoked-potential(BAEP)0-1,3,6,12months after born,respectively.ResultsAmong the 336 high risk infants,29 failed theexam inationsw ithin the1stmonth,37 cases failed in the3rdmonth,27 cases recovered in the9thmonth,and 7 cases recovered in the 12thmonth,3 caseswere finally diagnosed as deafness(0.89%).ConclusionOAE,ABR combining with BAEPexamination may obtain com prehensive diagnosis of hearing impairment for high risk infants,continuous listening com prehensionmonitoring can effectively dynam ically observe thehearing impairment,changesand outcomeof high risk infants.

high risk infants;hearing screening;otoacoustic emissions;auditory brainstem response;brainstem auditory-evoked potential;follow-up

10.3969/j.issn.1006-9771.2016.12.021

R246.81

B

1006-9771(2016)12-1459-03

2016-08-24

2016-09-05)

濱州市科技發展計劃項目(No.2014ZC0155)。

濱州醫學院附屬醫院兒科，山東濱州市256603。作者簡介：呂攀攀(1985-)，女，漢族，山東淄博市人，碩士，醫師，主要研究方向：高危兒篩查及早期干預。E-mail:lvpanpan163@163.com。