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目的探讨影响重度高胆红素血症新生儿听力损伤预后情况的相关因素。方法选择2008年11月至2009年10月本院新生儿科收治的重度高胆红素血症患儿,进行脑干听觉诱发电位(BAEP)的检测,对异常者分别于生后1个月、3个月、6个月、1岁时复查BAEP,直至BAEP恢复正常或年龄至1岁。按照随访时BAEP能否恢复正常分为随访正常组和随访异常组。对随访异常的影响因素进行单因素分析,并对单因素分析有统计学意义的因素纳入Logistic回归模型进行多因素分析。结果 967例重度高胆红素血症患儿中BAEP异常168例,其中150例按时进行随访的患儿纳入本研究。至随访结束,94.2%的轻度听力损伤者、85.5%的中度听力损伤者和19.2%的重度听力损伤者恢复正常。单因素分析结果显示,酸中毒、B/A比值、黄疸持续时间、BAEP异常程度、胆红素脑病临床表现是随访异常的影响因素。多因素Logistic回归分析结果显示,BAEP重度异常(OR=9.291)和胆红素脑病临床表现(OR=9.176)是听力损伤的重度高胆红素血症患儿随访异常的危险因素。结论新生儿重度高胆红素血症伴轻中度BAEP异常者1年内大多可恢复正常,但当存在BAEP重度异常和胆红素脑病临床表现时,1年内听力持续异常的可能性大,需要给予更加积极的神经康复治疗。
Objective To investigate the related factors that affect the prognosis of newborns with severe hyperbilirubinemia. Methods From November 2008 to October 2009, children with severe hyperbilirubinaemia admitted to our department of neonatology were enrolled in this study. The brainstem auditory evoked potentials (BAEP) were measured. The abnormalities were detected at 1 month, 3 months, 6 months, 1 year old review of BAEP until BAEP returned to normal or age to 1 year old. According to follow-up BAEP can be returned to normal follow-up normal group and follow-up abnormal group. Univariate analysis was performed on the influencing factors of follow-up abnormalities, and the factors that had statistical significance in univariate analysis were included in the Logistic regression model for multivariate analysis. Results Of the 967 children with severe hyperbilirubinaemia, 168 were abnormal in BAEP, of which 150 were followed up on time. At the end of follow-up, 94.2% of mild hearing impairment, 85.5% of moderate hearing loss and 19.2% of severe hearing loss returned to normal. Univariate analysis showed that acidosis, B / A ratio, duration of jaundice, abnormal BAEP, and clinical manifestations of bilirubin encephalopathy were the influencing factors of follow-up anomalies. Multivariate Logistic regression analysis showed that severe BAEP (OR = 9.291) and clinical manifestations of bilirubin encephalopathy (OR = 9.176) were risk factors for abnormal follow-up in children with severe hyperbilirubinaemia. Conclusions Most newborns with severe hyperbilirubinemia and mild to moderate BAEP may return to normal within 1 year. However, when BAEP is abnormal and the clinical manifestations of bilirubin encephalopathy are present, the possibility of persistent abnormal hearing within 1 year is high, Give more positive neurological rehabilitation.