熟悉小儿测听的都知道,最大的困难是婴幼儿的注意力太短,无法获得所有的听力数据。而谙熟脑干诱发电位测试的医生,最怕的是镇静后的小儿在测试中突然苏醒过来,导致测试结果不得不中断。中国听力学网的专家曾介绍过,熟练运用言语测听技术,我们能在几分钟内获得婴幼儿的主要听力数据,能判断是否听力正常与否。当年龄在4个月的婴幼儿熟睡时,我们最多能获得多少ABR的数据?这是一个有趣的问题,也有一定临床价值。因为,如果我们知道这答案,便能更有效地测试婴幼儿听力。
中国听力学网的数据显示,最近来自加拿大的著名的脑干诱发电位专家Stapells及其同事,为了回答这个问题,分析了从2005年到2007年间,测试的184名的188份ABR结果。他们发现其中有116名婴儿接受镇静剂,年龄中位数是23个月,72名婴儿没有接受镇静剂,年龄中位数是4个月。分析揭示,对于年龄超过6个月以上,大多接受镇静剂,主要使用水合氯醛,平均剂量是55+/- 12 mg/kg。
进一步分析这些结果显示,93名婴幼儿听力正常,91名婴幼儿确诊有听力损失。脑干诱发电位使用的刺激声时500、1000、2000和4000 Hz,ABR骨导测试的频率为500和2000Hz。在91名听力损失患者中37名患传导性听损,39名有感音性神经听力损失,6名患混合型听力损失,3名小儿则被发现有听神经病,6名小儿的听损原因不明。
从测试这些小儿的时间看,上述剂量的镇静剂能有58分钟的ABR测试时间,平均能获得7.6组数据;相比之下,自然条件下测试小儿,平均只有49分钟,大约能获得6.2组数据。虽然这两种情况获得数据不一,根据他们的分析,这些数据量的差别并没有影响测试结果的准确性。
当然,这项研究结论最重要的是,针对小儿的脑干诱发电位测试,一般在60分钟内,每只耳朵能分别测出500和2000Hz的阈值,以及2000Hz的骨导阈值。根据这些结果,临床医生基本能鉴定出婴幼儿的听力状况。中国听力学网的首席记者章邯评论说,这项研究的意义在于几点,首先我们应该保证每个婴儿有一个小时的脑干诱发电位测试时间,其次,我们应该充分利用这些时间,分别获得每只耳朵的气导和骨导ABR的结果,这样才能准确地鉴定婴幼儿的听力状况。
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) 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