CAJ | 학술논문

目的探讨自动听性脑干反应(automated auditory brainstem response,AABR)技术在新生儿听力筛查中的应用价值,分析新生儿听力障碍的高危因素. 方法对2009年3月1日至2011年10月31日期间,第三军医大学大坪医院野战外科研究所产科出生的活产儿共4961例进行回顾性分析,其中4833例在出生后48～72 h采用Algo3i型AABR听力筛查仪进行初筛,单耳或双耳未通过者于出生后30～42 d进行复筛,复筛仍未通过者进行进一步检查及诊断.记录新生儿的胎龄、性别、出生体重、身长、娩出方式、Apgar评分以及是否进入新生儿重症监护病房(neonatalintensive care unit,NICU)治疗,分析上述因素对听力筛查通过率的影响.组间比较采用x2检验.结果 (1)初筛率97.4％(4833/4961),初筛通过率90.3％(4362/4833).471例初筛未通过(双耳77例,右耳154例,左耳240例),其中33例失访,复筛率93.0％(438/471),复筛通过率91.3％(400/438).(2)38例婴儿复筛未通过,其中18例拒绝进一步检查,12例经过进一步检查未发现异常,8例确诊为听力障碍.初筛的敏感性和假阳性率分别为8/8和8.7％(418/4780),初筛和复筛总体的假阳性率为0.4％(18/4780),听力障碍检出率为1.67‰(8/4788).(3)有窒息史的新生儿初筛通过率低于无窒息史者[79.4％(27/34)与90.3％(4335/4799),x2=4.577,P＜0.05],左耳通过率低于右耳[93.4％(4516/4833)与95.2％(4602/4833),x2=14.307,P＜0.05],因各种原因进入NICU治疗的患儿通过率低于未进入NICU的新生儿[46.9％(113/241)与92.5％(4249/4592),x2=542.336,P＜0.05],差异均有统计学意义.不同出生体重、娩出方式、性别、胎龄、身长的新生儿比较,初筛通过率差异均无统计学意义(P＞0.05). 结论 AABR技术是有效的新生儿听力筛查手段.新生儿窒息和进入NICU治疗是听力障碍的高危因素.
목적 탐토자동은성뇌간반응(automated auditory brainstem response,AABR)기술재신생인은력사사중적응용개치,분석신생인은력장애적고위인소. 방법 대2009년3월1일지2011년10월31일기간,제삼군의대학대평의원야전외과연구소산과출생적활산인공4961례진행회고성분석,기중4833례재출생후48～72 h채용Algo3i형AABR은력사사의진행초사,단이혹쌍이미통과자우출생후30～42 d진행복사,복사잉미통과자진행진일보검사급진단.기록신생인적태령、성별、출생체중、신장、면출방식、Apgar평분이급시부진입신생인중증감호병방(neonatalintensive care unit,NICU)치료,분석상술인소대은력사사통과솔적영향.조간비교채용x2검험.결과 (1)초사솔97.4％(4833/4961),초사통과솔90.3％(4362/4833).471례초사미통과(쌍이77례,우이154례,좌이240례),기중33례실방,복사솔93.0％(438/471),복사통과솔91.3％(400/438).(2)38례영인복사미통과,기중18례거절진일보검사,12례경과진일보검사미발현이상,8례학진위은력장애.초사적민감성화가양성솔분별위8/8화8.7％(418/4780),초사화복사총체적가양성솔위0.4％(18/4780),은력장애검출솔위1.67‰(8/4788).(3)유질식사적신생인초사통과솔저우무질식사자[79.4％(27/34)여90.3％(4335/4799),x2=4.577,P＜0.05],좌이통과솔저우우이[93.4％(4516/4833)여95.2％(4602/4833),x2=14.307,P＜0.05],인각충원인진입NICU치료적환인통과솔저우미진입NICU적신생인[46.9％(113/241)여92.5％(4249/4592),x2=542.336,P＜0.05],차이균유통계학의의.불동출생체중、면출방식、성별、태령、신장적신생인비교,초사통과솔차이균무통계학의의(P＞0.05). 결론 AABR기술시유효적신생인은력사사수단.신생인질식화진입NICU치료시은력장애적고위인소.
Objective To investigate the significance of automated auditory brainstem response (AABR) technique in newborn hearing screening and the high-risk factors of newborns hearing disturbance.Methods From March 1,2009 to October 31,2011,4961 newborn infants were born in the Department of Obstetrics,Daping Hospital,the Third Military Medical University,among which 4833 cases received preliminary hearing screening by AABR (Algo3i equipment) at 48-72 h after birth.Those who failed in the preliminary screening received secondary screening at 30-42 d after birth.Those who failed again were referred to further investigations for final diagnosis.The gestational age,gender,body weight,body length,delivery mode,Apgar score and whether to be hospitalized in neonatal intensive care unit (NICU) of each newborn were recorded.The association between each factor and hearing screening passing rate was analyzed.Chi-square test was used to compare the results of different groups.Results (1) The preliminary screening rate was 97.4 ％(4833/4961) with a passing rate of 90.3％ (4362/4833).Four hundred and seventy-one infants did not pass the preliminary screening (77 cases for both ears,154 cases for right ear and 240 cases for left ear),among which 33 infants were lost in follow-up.The secondary screening rate was 93.0％ (438/471) with a passing rate of 91.3％ (400/438).(2) Thirty-eight infants did not pass the secondary screening,among which 18 cases rejected to receive further examination,and 12 cases showed normal and 8 cases were diagnosed as hearing disturbance by further examination.The sensitivity and false positive rate of preliminary screening with AABR were 8/8 and 8.7％ (418/4780)respectively.The total false positive rate of both preliminary and secondary screening were 0.4％(18/4780).The detection rate of hearing disturbance was 1.67‰ (8/4788).(3) In preliminary screening,the passing rate of infants with asphyxia was lower than that of those without asphyxia [79.4％ (27/34) vs 90.3％ (4335/4799),x2 =4.577,P＜0.05].The passing rate of left ears was lower than that of right ears [93.4％ (4516/4833) vs 95.2％ (4602/4833),x2 =14.307,P＜0.05].The passing rate of infants who were admitted to NICU was lower than those who were not [46.9％(113/241) vs 92.5％ (4249/4592),x2 =542.336,P＜0.05].No significance of the passing rate of preliminary screening was found in different body weight,delivery modes,genders,gestational ages and body length groups (P＞0.05).Conclusions AABR can be an effective way in newborn hearing screening.History of asphyxia and NICU hospitalization are high-risk factors of hearing disturbance in newborn infants.