本文選題：新生兒重度高膽紅素血癥 + 聽力損傷　； 參考：《上海交通大學(xué)學(xué)報(bào)(醫(yī)學(xué)版)》2017年10期

【摘要】：目的·探討重度高膽紅素血癥患兒聽力損傷相關(guān)高危因素和隨訪預(yù)后。方法·對(duì)2015年6月至2016年6月上海兒童醫(yī)學(xué)中心新生兒科收治的106例重度高膽紅素血癥患兒,按照膽紅素水平分為3組:重度高膽紅素血癥組[血清總膽紅素(TSB)峰值大于342.0μmol/L且小于427.5μmol/L]、極重度高膽紅素血癥組(TSB峰值范圍427.5~513.0μmol/L)、危險(xiǎn)性高膽紅素血癥組(TSB峰值大于513.0μmol/L)。在出院前用自動(dòng)腦干聽覺誘發(fā)電位(AABR)進(jìn)行聽力篩查,對(duì)篩查未通過(guò)的患兒于3月齡時(shí)進(jìn)行診斷性腦干聽覺誘發(fā)電位(ABR)檢查,并對(duì)所有患兒(3月齡和6月齡)隨訪聽性行為反應(yīng)觀察狀況。結(jié)果·3組患兒共106例,出院前AABR篩查未通過(guò)33例(33/106,31.13%),其中重度高膽紅素血癥組未通過(guò)22例(22/86,25.58%),極重度高膽紅素血癥組未通過(guò)9例(9/16,56.25%),危險(xiǎn)性高膽紅素血癥組未通過(guò)2例(2/4,50.00%),各組之間差異有統(tǒng)計(jì)學(xué)意義(均P0.05)。通過(guò)專人負(fù)責(zé)定期宣教,出院前AABR篩查未通過(guò)的33例患兒全都于3月齡時(shí)來(lái)院接受診斷性ABR檢查,結(jié)果 2例患兒被診斷為輕度聽力損傷,但其中1例考慮為中耳炎所致。同時(shí),全部106例重度高膽紅素血癥患兒完成3月齡和6月齡聽性行為反應(yīng)觀察,結(jié)果狀況良好。結(jié)論·重度高膽紅素血癥是新生兒聽力損傷的高危因素之一,TSB水平越高,聽力損傷也越明顯。重度高膽紅素血癥引起的聽力損傷可能可逆,但也提示聽力隨訪計(jì)劃有待完善。重度高膽紅素血癥造成的聽力損傷可能對(duì)患兒日常生活無(wú)明顯影響,仍需對(duì)患兒進(jìn)行長(zhǎng)期隨訪。
[Abstract]:Objective to investigate the risk factors and prognosis of hearing loss in children with severe hyperbilirubinemia. Methods from June 2015 to June 2016, 106 children with severe hyperbilirubinemia were treated by Shanghai Children's Medical Center. According to the level of bilirubin, it was divided into three groups: severe hyperbilirubinemia group [serum total bilirubin peak value > 342.0 渭 mol/L and less than 427.5 渭 mol/L], extremely severe hyperbilirubinemia group with TSB peak value of 427.5V 513.0 渭 mol / L, and risk hyperbilirubinemia group with TSB peak value greater than 513.0 渭 mol / L. Automatic brainstem auditory evoked potential (AABR) was used for hearing screening before discharge, and diagnostic brainstem auditory evoked potential (ABR) was examined in children who failed the screening at the age of 3 months. All the children were followed up for 3 months and 6 months of age. Results there were 106 cases in 3 groups. Before discharge, 33 cases of AABR did not pass 33 / 10 / 10 6 / 31.13, including 22 cases of severe hyperbilirubinemia group, 9 cases of very severe hyperbilirubinemia group and 9 cases of very severe hyperbilirubinemia group, and 2 cases of dangerous hyperbilirubinemia group did not pass 2 / 4 50.005%, the difference was statistically significant (P 0.05). 33 children who failed AABR screening before discharge were all admitted to hospital for diagnostic ABR examination at 3 months of age. The results showed that 2 cases were diagnosed as mild hearing impairment, but 1 case was considered to be caused by otitis media. At the same time, all 106 children with severe hyperbilirubinemia completed 3 and 6 months of auditory behavioral response observation, the results were good. Conclusion severe hyperbilirubinemia is one of the high risk factors of neonatal hearing loss. The hearing loss caused by severe hyperbilirubinemia may be reversible, but it also suggests that the hearing follow-up plan needs to be improved. The hearing loss caused by severe hyperbilirubinemia may not affect the daily life of the children.
【作者單位】： 上海交通大學(xué)醫(yī)學(xué)院附屬上海兒童醫(yī)學(xué)中心新生兒科;
【分類號(hào)】：R722.1

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