山东大学耳鼻喉眼学报 ›› 2022, Vol. 36 ›› Issue (1): 20-24.doi: 10.6040/j.issn.1673-3770.0.2021.350
盘琳琳1,方旭华1,翟丰1,桂一丁2,边洲亮3,陈洁1
PAN Linlin1, FANG Xuhua1, ZHAI Feng1, GUI Yiding2, BIAN Zhouliang3, CHEN Jie1
摘要: 目的 探讨新生儿动脉血血气分析指标与听力筛查结果的关系。 方法 回顾性分析医学中心新生儿科496例患儿听力筛查结果和入院时动脉血血气分析指标。 结果 自动听觉脑干反应(AABR)、畸变产物耳声发射(DPOAE)和声导抗和总听力筛查通过率分别为61.9%(307/496)、61.3%(304/496)、90.1%(447/496)和56.7%(281/496)。三种听力筛查方法通过率差异有统计学意义(χ2=131.00,P<0.001)。AABR与DPOAE测试结果一致性极强(Kappa=0.817,P<0.001),两者与声导抗测试一致性较弱(Kappa值分别为0.262、0.256,P均<0.001)。单因素Logisitic分析显示乳酸升高(OR=0.544,P=0.001)、二氧化碳分压升高(OR=1.917,P=0.009)、pH降低(OR=1.692,P=0.021)与听力筛查不通过显著相关。多因素Logisitic分析显示,乳酸(OR=0.627,P=0.018)、氧分压(OR=1.493,P=0.047)与听力筛查结果不通过显著相关。二氧化碳分压、pH和血氧饱和度和听力筛查结果无明显相关性(P>0.05)。 结论 新生儿缺氧及其伴随的血气变化可能会影响听力筛查结果。
中图分类号:
[1] Yun CF, Wang ZJ, Gao JM, et al. Prevalence and social risk factors for hearing impairment in Chinese children-A national survey[J]. Int J Environ Res Public Health, 2017, 14(1): E88. doi:10.3390/ijerph14010088. [2] Joint Committee on Infant Hearing. Year 2007 position statement: principles and guidelines for early hearing detection and intervention programs[R]. American Speech-Language-Hearing Association, 2007. doi:10.1044/policy.ps2007-00281. [3] Howell JB, Appelbaum EN, Armstrong MF, et al. An analysis of risk factors in unilateral versus bilateral hearing loss[J]. Ear Nose Throat J, 2019, 98(6): 330-333. doi:10.1177/0145561319840578. [4] Rei M, Ayres-de-Campos D, Bernardes J. Neurological damage arising from intrapartum hypoxia/acidosis[J]. Best Pract Res Clin Obstet Gynaecol, 2016, 30: 79-86. doi:10.1016/j.bpobgyn.2015.04.011. [5] Leite JN, Silva VS, Buzo BC. Emissões otoacústicas em recém-nascidos com hipóxia perinatal leve e moderada[J]. CoDAS, 2016, 28(2): 93-98. doi:10.1590/2317-1782/20162015086. [6] Fitzgerald MP, Reynolds A, Garvey CM, et al. Hearing impairment and hypoxia ischaemic encephalopathy: Incidence and associated factors[J]. Eur J Paediatr Neurol, 2019, 23(1):81-86. doi: 10.1016/j.ejpn.2018.10.002. [7] 盘琳琳,孔令漪,翟丰,等. 新生儿听力障碍常见危险因素及听力筛查方法研究进展[J]. 山东大学耳鼻喉眼学报, 2022, 36(1):131-137. doi: 10.6040/j.issn.1673-3770.0.2021.080. PAN Linlin, KONG Lingyi, ZHAI Feng, et al. Research progress on auditory risk factors and hearing screening methods among neonates[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2022, 36(1):131-137. doi: 10.6040/j.issn.1673-3770.0.2021.080. [8] Zhai F, Fang XH, Li YB, et al. Risk factors for failure in first-time hearing screening tests among high-risk neonates in neonatal intensive care unit[J]. Audiol Neurootol, 2021, 26(5): 338-345. doi:10.1159/000512761. [9] 国家卫生和计划生育委员会新生儿疾病筛查听力诊断治疗组. 婴幼儿听力损失诊断与干预指南[J]. 中华耳鼻咽喉头颈外科杂志, 2018, 53(3): 181-188. doi:10.3760/cma.j.issn.1673-0860.2018.03.004. [10] Kvestad E, Lie KK, Eskild A, et al. Sensorineural hearing loss in children: the association with Apgar score. A registry-based study of 392, 371 children in Norway[J]. Int J Pediatr Otorhinolaryngol, 2014, 78(11): 1940-1944. doi:10.1016/j.ijporl.2014.08.032. [11] Jiang ZD, Zang Z, Wilkinson AR. Cochlear function in 1-year-old term infants born with hypoxia-ischaemia or low Apgar scores[J]. J Paediatr Child Health, 2012, 48(2): 160-165. doi:10.1111/j.1440-1754.2011.02066.x. [12] 苏关影. 脐血动脉血气分析联合apgar评分在新生儿窒息病情评价中的应用价值[J]. 中外医学研究, 2021, 19(15): 45-47. doi:10.14033/j.cnki.cfmr.2021.15.017. SU Guanying. Application value of umbilical cordblood arterial blood gas analysis combined with apgar score in illness evaluation of neonatal asphyxia[J]. Chinese and Foreign Medical Research, 2021, 19(15): 45-47.doi:10.14033/j.cnki.cfmr.2021.15.017. [13] Sohmer H, Freeman S, Schmuel M. ABR threshold is a function of blood oxygen level[J]. Hear Res, 1989, 40(1/2): 87-91. doi:10.1016/0378-5955(89)90102-0. [14] 杨万超, 刘翔, 陈剑峰, 等. 高碳酸血症对严重低氧缺血大鼠脑损伤的影响[J]. 临床麻醉学杂志, 2017, 33(5): 473-477. doi:10.3969/j.issn.1004-5805.2017.05.015. YANG Wanchao, LIU Xiang, CHEN Jianfeng, et al.Effect of hypercapnia on blood brain barrier in rats with severe hypoxic-ischemic brain injury[J]. Journal of Clinical Anesthesiology, 2017, 33(5): 473-477. doi:10.3969/j.issn.1004-5805.2017.05.015. [15] Koyama S, Kaga K, Sakata H, et al. Pathological findings in the temporal bone of newborn infants with neonatal asphyxia[J]. Acta Otolaryngol, 2005, 125(10): 1028-1032. doi:10.1080/00016480410023092. [16] 李世成, 田野. 间歇性缺氧模拟高原训练对小鼠骨骼肌乳酸代谢的影响[J]. 中国运动医学杂志, 1999, 18(2): 126-128. doi:10.16038/j.1000-6710.1999.02.011. LI Shicheng, TIAN Ye. Effects of training atmoderate altitude on lactic acid metabolism of skeletal muscles[J]. Chinese Jouranal of Sports Medicine, 1999, 18(2): 126-128. doi:10.16038/j.1000-6710.1999.02.011. [17] Ferguson BS, Rogatzki MJ, Goodwin ML, et al. Lactate metabolism: historical context, prior misinterpretations, and current understanding[J]. Eur J Appl Physiol, 2018, 118(4): 691-728. doi:10.1007/s00421-017-3795-6. [18] 施风泉, 邱洪生, 李文忠, 等. 新生儿缺氧缺血性脑病严重程度与动脉血乳酸、脑脊液乳酸水平的相关性[J]. 实用临床医药杂志, 2020, 24(17): 86-88. doi:10.7619/jcmp.202017023. SHI Fengquan, QIU Hongsheng, LI Wenzhong, et al. Correlations between severity of neonatal hypoxic ischemic encephalopathy and levels of arterial blood lactic acid as well as cerebrospinal fluid lactic acid[J]. Journal of Clinical Medicine in Practice, 2020, 24(17): 86-88. doi:10.7619/jcmp.202017023. [19] Jiang ZD, Shao XM, Wilkinson AR. Brainstem auditory-evoked responses in full-term newborn infants with temporary low Apgar score[J]. Acta Oto Laryngol, 2005, 125(2): 163-168. doi:10.1080/00016480410017684. |
[1] | 倪坤,孙世冰,李晓艳. 1 000 Hz声导抗在高危新生儿听力筛查中的应用[J]. 山东大学耳鼻喉眼学报, 2022, 36(1): 43-47. |
[2] | 盘琳琳,孔令漪综述翟丰,陈洁审校. 新生儿听力障碍常见危险因素及听力筛查方法研究进展[J]. 山东大学耳鼻喉眼学报, 2022, 36(1): 131-137. |
[3] | 马小雨,边晓敏综述于丹审校. 单羧酸转运蛋白家族与头颈部鳞状细胞癌的研究进展[J]. 山东大学耳鼻喉眼学报, 2021, 35(2): 125-130. |
[4] | 王国强, 赵春红, 霍红, 龚志云, 宋伟伟, 严丽霞, 李雪华, 王伟丽. 早产儿听力筛查结果及其听力障碍危险因素[J]. 山东大学耳鼻喉眼学报, 2015, 29(4): 7-10. |
[5] | 周晓娓, 王跃建, 段光荣, 虞幼军. 听力诊疗网络平台的开发[J]. 山东大学耳鼻喉眼学报, 2014, 28(6): 79-84. |
[6] | 余崇仙,杨克林,张晓敏,汪平 . 听力筛查未通过婴幼儿的客观听力评估[J]. 山东大学耳鼻喉眼学报, 2013, 27(6): 38-41. |
[7] | 刘志奇1,2,刘立思1,杨琨3 . 新生儿听力筛查11894例结果分析[J]. 山东大学耳鼻喉眼学报, 2013, 27(2): 8-12. |
[8] | 张恩东,李大建,苗乐杰. 重症监护病房与母婴同室新生儿听力筛查比较[J]. 山东大学耳鼻喉眼学报, 2011, 25(2): 29-31. |
[9] | 张俊瑶 朱富高 孙美红. 6159例新生儿听力筛查结果分析[J]. 山东大学耳鼻喉眼学报, 2009, 23(4): 38-40. |
[10] | 杨 琨,刘志奇,黄治物 . 正常新生儿226Hz及1000Hz探测音鼓室导抗测试[J]. 山东大学耳鼻喉眼学报, 2008, 22(5): 420-423 . |
[11] | 曲 玲 . 243例未通过听力筛查的婴幼儿ABR结果分析[J]. 山东大学耳鼻喉眼学报, 2008, 22(2): 189-190 . |
|