本文選題：高危兒 + 聽力障礙　； 參考：《廣州中醫(yī)藥大學(xué)》2012年碩士論文

【摘要】：研究背景： 近年來隨著圍生醫(yī)學(xué)的大力發(fā)展,新生兒重癥監(jiān)護室的設(shè)立以及現(xiàn)代搶救技術(shù)的提高,高危兒的生存率大大提高,但這些新生兒常遺留有不同程度的后遺癥,其中之一就是聽力障礙。有研究表明,高危兒聽力障礙的發(fā)病率為2.1%,而我國高危兒的發(fā)生率較高，，約占新生嬰兒的60%,根據(jù)我國2009年國民經(jīng)濟和社會發(fā)展統(tǒng)計公報數(shù)據(jù),我們每年出生1615萬新生兒,如果按此數(shù)據(jù)推算,我國每年將新增二十余萬名聽力障礙的患兒。聽力障礙可直接引起二次障礙,即言語發(fā)育障礙及智力發(fā)育障礙。故早期識別和治療,高危兒的聽力障礙,可最大程度降低聽力損傷所造成的不良后果。腦干聽覺誘發(fā)電位(BAEP)記錄的是聽覺傳導(dǎo)通路中的神經(jīng)電位活動.反映耳蝸至腦干相關(guān)結(jié)構(gòu)的功能狀況。作為聽力障礙的一個敏感指標(biāo),已被用于嬰幼兒聽力障礙的診斷和轉(zhuǎn)歸。 研究目的： 觀察針刺聽宮、聽會、翳風(fēng)、暈聽區(qū)對高危兒嬰兒期異常BAEP的影響。 研究方法：本課題采用隨機對照研究的試驗方法,將腦干聽覺誘發(fā)電位(BAEP)異常的患兒隨機分為針刺治療組即干預(yù)組(32例)和一般治療組即對照組(31例)。對照組采用常規(guī)治療,干預(yù)組在常規(guī)治療基礎(chǔ)上加針刺治療(隔日針刺)(基本穴：暈聽區(qū)聽宮、聽會、翳風(fēng)：實證加雙合谷,雙太沖；虛證加雙三陰交,雙太溪),20天/1療程×3療程。治療前后觀察腦干聽覺誘發(fā)電位(BAEP)聽閾、各波潛伏期及峰間期的變化。運用統(tǒng)計軟件13.0建立數(shù)據(jù)庫并進行統(tǒng)計學(xué)分析。 結(jié)果： 1.干預(yù)組總有效率85.5%,對照組總有效率66.7%,差異有統(tǒng)計學(xué)意義(p0.05)。 2.兩組患兒治療后BAEP各指標(biāo)比較,雙耳聽閾、Ⅰ波潛伏期、Ⅲ波潛伏期、ⅠⅢ峰間期差異具有統(tǒng)計學(xué)意義,Ⅴ波潛伏期、Ⅲ-Ⅴ峰間期、Ⅰ-Ⅴ峰間期差異無統(tǒng)計學(xué)意義。 3.兩組患兒因核黃疸所導(dǎo)致的聽力障礙,治療前后無變化,聽閾均大于102dB,均未見波形分化。 結(jié)論： (1)針刺療法對高危兒的聽力障礙具有較好治療效果,總有效率為85.5%。 (2)針刺療法對高危兒嬰兒期的異常BAEP具有較好的改善作用,在外周障礙型以及病變在腦干下段時明顯：對于腦干障礙型,病變在腦干上段,即橋腦與中腦平面,以及整個腦干聽覺傳導(dǎo)通路受損時改善不明顯。 (3)高危因素與BAEP異常的關(guān)系：核黃疸所導(dǎo)致的聽力障礙,BAEP異常程度最重,療效最差；其他多高危因素導(dǎo)致的聽力障礙,BAEP異常程度較重,治療后療效欠佳：單一高危因素導(dǎo)致的聽力障礙，BAEP異常程度一般較輕,治療后療效較好,甚至完全恢復(fù)。
[Abstract]:Background: in recent years, with the development of perinatal medicine, the establishment of neonatal intensive care unit and the improvement of modern rescue technology, the survival rate of high-risk infants has been greatly improved. But these newborns often have varying degrees of sequelae, one of which is hearing impairment. Studies have shown that the incidence of hearing impairment among high-risk children is 2.1, while the incidence of high-risk children in China is relatively high, accounting for about 60% of newborn babies. According to the 2009 National Economic and Social Development Statistics Bulletin of our country, we have 16.15 million newborns born every year. According to this data, China will add more than 200,000 children with hearing impairment each year. Hearing disorders can directly cause secondary disorders, namely speech developmental disorders and intellectual developmental disorders. Therefore, early identification and treatment of high risk children with hearing impairment can minimize the adverse consequences of hearing impairment. Brainstem auditory evoked potential (BAEP) records nerve potential activity in auditory conduction pathway. To reflect the functional status of cochlear to brainstem related structures. As a sensitive indicator of hearing impairment, it has been used in the diagnosis and outcome of hearing impairment in infants. Objective: to observe the effect of acupuncture on abnormal BAEP in infants with high risk infants. Methods: children with abnormal brainstem auditory evoked potential (BAEP) were randomly divided into acupuncture treatment group (32 cases) and general treatment group (31 cases). The control group was treated with routine therapy, the intervention group was treated with acupuncture on the basis of routine treatment (acupuncture every other day) (basic points: hearing area of dizzy hearing area, hearing meeting, Yifeng: positive evidence plus Shuanghegu, Shuangtai Chong, deficiency syndrome plus double Sanyinjiao), Shuang Tai Xi) 20 days / 1 course of treatment 脳 3 courses of treatment. The auditory evoked potential (BAEP) threshold, latency and interpeak period were observed before and after treatment. Statistical software 13.0 was used to establish database and statistical analysis. Results: 1. The total effective rate was 85.5 in the intervention group and 66.7 in the control group, the difference being statistically significant (p0.05). There were significant differences in BAEP indexes between the two groups after treatment. There were significant differences in auditory threshold, latency of wave 鈪

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