孔敏
【摘 要】目的:分析自動(dòng)聽性腦干誘發(fā)電位用于新生兒聽力篩查準(zhǔn)確性的影響因素。方法:選出我院2018年1~9月的81例(162耳)新生兒,應(yīng)用自動(dòng)聽性腦干誘發(fā)電位對(duì)其進(jìn)行聽力篩查,統(tǒng)計(jì)篩查通過率,同時(shí)收集新生兒的性別、胎齡、出生體重、產(chǎn)婦年齡、分娩方式、耳別等資料,分析其對(duì)聽力篩查準(zhǔn)確性的影響。結(jié)果:81例新生兒中,初篩結(jié)果通過64例,初篩通過率為79.0%;17例復(fù)篩,通過12例,復(fù)篩通過率為70.6%;5例轉(zhuǎn)診診斷,隨訪3個(gè)月,明確診斷為聽力障礙2例,確診率為40.0%。將初篩通過者納入觀察組,未通過者納入對(duì)照組,對(duì)比兩組的胎齡、出生體重、產(chǎn)婦年齡、耳別,差異均有統(tǒng)計(jì)學(xué)意義(P<0.05);對(duì)比兩組的性別、分娩方式,差異均無統(tǒng)計(jì)學(xué)意義(P>0.05)。多因素Logistic回歸分析結(jié)果顯示,胎齡、出生體重是新生兒聽力篩查準(zhǔn)確性的保護(hù)因素,產(chǎn)婦年齡、耳別是其危險(xiǎn)因素。結(jié)論:自動(dòng)聽性腦干誘發(fā)電位用于新生兒聽力篩查的準(zhǔn)確性較高,胎齡、出生體重、產(chǎn)婦年齡、耳別是影響聽力篩查準(zhǔn)確性的相關(guān)因素,應(yīng)重視新生兒聽力篩查,及早診治聽力障礙。
【關(guān)鍵詞】自動(dòng)聽性腦干誘發(fā)電位;新生兒;聽力篩查;準(zhǔn)確性;影響因素
【中圖分類號(hào)】R764 【文獻(xiàn)標(biāo)識(shí)碼】A 【文章編號(hào)】1004-7484(2019)01-0026-02
【Abstract】objective: to analyze the influencing factors of the accuracy of automatic auditory brainstem evoked potential (aep) in neonatal hearing screening. Methods: to select our hospital from January 2018 to September 81 cases (162 ears) of newborn and applied automatically to brainstem evoked potential for hearing screening, screening pass rate statistics, at the same time to collect the newborn's gender, gestational age, birth weight and maternal age, childbirth way, ear don't such information, to analyze its impact on the accuracy of hearing screening. Results: among the 81 neonates, 64 of them passed the screening test, and the screening rate was 79.0%. The rescreening rate was 70.6% in 12 cases. Five cases were referred for diagnosis and followed up for 3 months. 2 cases were definitely diagnosed with hearing impairment, with a diagnosis rate of 40.0%. Those who passed the initial screening were included in the observation group, while those who failed were included in the control group. The differences in gestational age, birth weight, maternal age and ear difference between the two groups were statistically significant (P<0.05). There was no significant difference in gender and delivery mode between the two groups (P>0.05). Multivariate Logistic regression analysis showed that gestational age and birth weight were protective factors for the accuracy of newborn hearing screening, and maternal age and ear were risk factors. Conclusion: the accuracy of automatic auditory brainstem evoked potential in neonatal hearing screening is relatively high. Gestational age, birth weight, maternal age, and especially the relevant factors affecting the accuracy of hearing screening should be paid more attention to neonatal hearing screening and early diagnosis and treatment of hearing impairment.
【key words】automatic auditory brainstem evoked potential; The newborn; Hearing screening; Accuracy; Factors affecting the
目前,針對(duì)新生兒的聽力篩查,自動(dòng)聽性腦干誘發(fā)電位獲得了廣泛應(yīng)用,能夠準(zhǔn)確反映新生兒的聽力受損情況[1]。本研究為了進(jìn)一步分析自動(dòng)聽性腦干誘發(fā)電位用于新生兒聽力篩查準(zhǔn)確性的影響因素,就我院81例新生兒的聽力篩查情況展開分析,匯報(bào)如下。
1 資料與方法
1.1 一般資料
選出我院2018年1~9月的81例(162耳)新生兒,其中男42例,女39例;胎齡34~42周,平均(39.7±1.1)周;出生體重2.7~4.1kg,平均(3.3±0.4)kg;產(chǎn)婦年齡22~43歲,平均(29.5±6.3)歲;分娩方式中,剖宮產(chǎn)33例,陰道分娩48例。
1.2 方法
1.2.1 聽力篩查方法
參照《新生兒聽力篩查技術(shù)規(guī)范》[2]相關(guān)標(biāo)準(zhǔn),于新生兒睡眠時(shí)在篩查室內(nèi)(噪聲低于40dB A)進(jìn)行聽力篩查,初篩運(yùn)用國(guó)際聽力OtoRead TEOAE(丹麥),復(fù)篩運(yùn)用麥科MB11自動(dòng)聽性腦干誘發(fā)電位檢測(cè)儀(德國(guó))。將電極膏涂于新生兒乳突下部、耳垂上部、顱頂電極的直線方向,電極置于電極膏涂抹區(qū)域,確保其與新生兒頭部良好接觸,且通過阻抗測(cè)試。避開新生兒視線,測(cè)試聲音為35dB SPL,觀察新生兒的聽性反射,測(cè)試結(jié)果分為通過、未通過兩項(xiàng),未通過者進(jìn)行轉(zhuǎn)診診斷。
1.2.2 影響聽力篩查準(zhǔn)確性的相關(guān)因素分析
收集新生兒的性別(男、女)、胎齡(<37周、≥37周)、出生體重(<3kg、≥3kg)、產(chǎn)婦年齡(<36歲、≥36歲)、分娩方式(剖宮產(chǎn)、陰道分娩)、耳別(左耳、右耳)等資料,分析其對(duì)聽力篩查準(zhǔn)確性的影響。
1.3 統(tǒng)計(jì)學(xué)方法
應(yīng)用SPSS 19.0軟件處理數(shù)據(jù),計(jì)數(shù)資料以n、%表示,行x?檢驗(yàn),計(jì)量資料以(±s)表示,行t檢驗(yàn),相關(guān)因素分析采用Logistic回歸分析,P<0.05說明差異有統(tǒng)計(jì)學(xué)意義。
2 結(jié)果
2.1 新生兒的聽力篩查結(jié)果分析
81例新生兒中,初篩結(jié)果通過64例,初篩通過率為79.0%;17例復(fù)篩,通過12例,復(fù)篩通過率為70.6%;5例轉(zhuǎn)診診斷,隨訪3個(gè)月,明確診斷為聽力障礙2例,確診率為40.0%。
2.2 影響新生兒聽力篩查準(zhǔn)確性的單因素分析
將初篩結(jié)果通過的64例新生兒納入觀察組,未通過的17例新生兒納入對(duì)照組,對(duì)比兩組新生兒的臨床資料,結(jié)果顯示,在胎齡、出生體重、產(chǎn)婦年齡、耳別的對(duì)比中,兩組差異均有統(tǒng)計(jì)學(xué)意義(P<0.05);而在性別、分娩方式的對(duì)比中,兩組差異均無統(tǒng)計(jì)學(xué)意義(P>0.05)。見表1。
2.3 影響新生兒聽力篩查準(zhǔn)確性的多因素分析
以新生兒聽力篩查準(zhǔn)確性為因變量,將胎齡、出生體重、產(chǎn)婦年齡、耳別設(shè)為自變量,進(jìn)行多因素Logistic回歸分析,根據(jù)OR值可知,胎齡、出生體重是新生兒聽力篩查準(zhǔn)確性的保護(hù)因素,產(chǎn)婦年齡、耳別是其危險(xiǎn)因素。見表2。
3 討論
聽在新生兒的缺陷疾病中,聽力障礙極為多見,且具有較高的患病率[3]。聽力障礙若未及早診斷并治療,會(huì)嚴(yán)重影響新生兒的聽力發(fā)展,還會(huì)在一定程度上降低其生活質(zhì)量[4]。父母識(shí)別以及臨床常規(guī)體檢極難在小兒1歲前對(duì)其聽力障礙進(jìn)行有效判斷。新生兒期聽力篩查工作的開展,可及時(shí)發(fā)現(xiàn)聽力障礙,繼而對(duì)患兒進(jìn)行有效的聽力康復(fù)訓(xùn)練,這對(duì)新生兒的健康成長(zhǎng)具有重要意義[5]。
本研究應(yīng)用自動(dòng)聽性腦干誘發(fā)電位對(duì)新生兒進(jìn)行聽力篩查,結(jié)果診斷出2例聽力障礙,確診率為2.5%。研究另對(duì)比分析了初篩結(jié)果通過者與未通過者的臨床資料,結(jié)果顯示,兩組的胎齡、出生體重、產(chǎn)婦年齡、耳別對(duì)比差異均有統(tǒng)計(jì)學(xué)意義(P<0.05),提示上述幾項(xiàng)指標(biāo)均為新生兒聽力篩查的準(zhǔn)確性的影響因素,進(jìn)一步的多因素Logistic回歸分析發(fā)現(xiàn),胎齡、出生體重是新生兒聽力篩查準(zhǔn)確性的保護(hù)因素,產(chǎn)婦年齡、耳別是其危險(xiǎn)因素。
綜上所述,自動(dòng)聽性腦干誘發(fā)電位用于新生兒聽力篩查的準(zhǔn)確性較高,胎齡、出生體重、產(chǎn)婦年齡、耳別是影響聽力篩查準(zhǔn)確性的相關(guān)因素,應(yīng)重視新生兒聽力篩查,及早診治聽力障礙。
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