摘要
目的 探讨声诱发反应(acoustic stimulation test,AST)在胎膜早破(prelabor rupture of membranes,PROM)胎儿听力监测中的可行性.方法 选取2018年6月—2021年12月宁德师范学院附属宁德市医院妇产科收治的2725例PROM孕妇作为PROM组,根据PROM发生时阴道分泌物病原体检测结果分为生殖道感染(reproductive tract infections,RTI)组(阳性)918例和无RTI组(阴性)1807例;再根据胎龄进一步划分为足月组(孕期≥37 周)1792例和早产组(28周≤孕期<37周)933例,为以上受试者行AST检测和新生儿听力筛查及诊断.同时,选取无PROM受试者600例作为对照组,最后将各组结果进行对比.结果 RTI组足儿和早产儿的AST阳性率均明显低于无RTI组和对照组,差异有统计学意义(P<0.05);3月龄时,PROM组足月儿和早产儿的声导抗和畸变产物耳声发射(DPOAE)与对照组比较,差异无统计学意义(P>0.05),但其V波阈值明显高于无PROM组;6月龄时,PROM组足月儿和早产儿的声导抗、DPOAE及V波阈值与对照组比较,差异均无统计学意义(P>0.05);在听力损失随访幼儿中,起初超过一半患儿的声导抗异常,而DPOAE通过率低、V波阈值差.随着月龄增加,各组患儿(PROM组足月儿除外)的声导抗异常率、DPOAE通过率及V波阈值均出现明显改善;在阳性AST,PROM组及对照组患儿听力损失多为轻、中度;在阴性AST,PROM组患儿听力损失多为单或双耳中、重度,而对照组则多为同时双耳;AST对筛查胎儿听力损失的曲线下面积(Area under the curve,AUC)为0.821,联合DPOAE的AUC则为0.915,高于单独使用AST或DPOAE,对重度和极重度者具有很好的敏感度.结论 AST可以较好地反映与预估PROM宫内胎儿听力,可供临床选择/联合使用;尤其是RTI阴性者,其听力损失率较高,应加强此类患儿的听力跟踪与随访.
Abstract
Objective To investigate the feasibility of fetal hearing monitoring in prelabor rupture of membranes(PROM)using acoustic stimulation test.Methods Pregnant women with PROM admitted to the Department of Obstet-rics and Gynecology,Ningde Hospital affiliated to Ningde Normal University from June 2018 to December 2021(n= 2725)were divided into a reproductive tract infection(RTI)group(n=918)and a non-RTI group(n=1807)based on their vaginal secretion pathogen test results at the time of PROM.By gestational age,1792 cases were full-term(pregnancy≥37 weeks)and 933 cases were premature(pregnancy≤28 weeks<37 weeks).Non-PROM newborns(n=600)were used as control.All PROM subjects received AST followed by neonatal hearing screening and diagnostic testing as indicated.Results were compared among the groups.Results The rate of positive AST was lower in premature and full-term RTI newborns than that in non-RTI newborns and controls(P<0.05).At 3 months,acoustic impedance and DPOAE findings were similar between full-term and preterm PROM infants and controls(P>0.05),although their ABR wave V thresh-olds were higher than those in non-PROM infants.At 6 months,acoustic impedance,DPOAEs and wave V thresholds were all similar among PROM and non-PROM infants,full-term or preterm(P>0.05).Among infants with confirmed hearing loss,more than half initially had abnormal acoustic impedance,low DPOAE pass rate and elevated wave V thresholds,although all of these indices improved along with age in all groups excluding full-term PROM infants.Hear-ing loss was generally mild or moderate in those with positive AST,but tended to be moderate or severe or involving both ears in those with negative AST.The area under curve(AUC)for AST in detecting fetal hearing loss was 0.821,and 0.915 when combined with DPOAEs,especially for severe and profound hearing loss.Conclusion AST can be used to detect and predict fetal hearing loss in PROM in selected cases,especially when confounded with RTI,where negative AST is associated with increased probability of hearing loss.Negative AST in PROM indicates the need hearing moni-toring and follow-ups.
国家科技期刊平台
NSTL
万方数据