新生儿重症监护病房噪音对早产儿听力及智力发育的影响

Effect of noise on the auditory system and the intelligence development of premature infants treated in the neonatal intensive care unit

摘要:

目的：一些基层医院新生儿重症监护病房(NICU)中高于70 dB噪音很常见。该研究旨在探讨NICU噪音对早产儿听力及智力发育的影响。方法：NICU中呼吸窘迫综合征需机械通气治疗的早产儿100例，随机分为2组，其中观察组呼吸机治疗时使用耳罩，对照组呼吸机治疗时不使用耳罩。呼吸机治疗结束后，分别进行听性脑干诱发电位、头颅B超、婴幼儿智力发育测评。结果：呼吸机治疗结束后2~3 d，观察组总听力损失（23% vs 47%）和轻度听力损失比例（15% vs 35%）明显低于对照组（P<0.05）；头颅B超检查早产儿脑室周围-脑室内出血与脑室周围白质软化发病率，发现观察组低于对照组（21%vs 42%；P<0.05）；生后6个月及12个月时观察组智力发育指数及运动发育指数明显高于对照组（P<0.05）。结论：NICU噪音可造成早产儿轻度听力损失，还可使早产儿脑室周围-脑室内出血与脑室周围白质软化发生率上升，智力发育落后，而配戴耳罩可以减轻此类不良影响。［中国当代儿科杂志，2009，11（12）：976-979］

Abstract:

OBJECTIVE: High noise levels (>70 dB) in the neonatal intensive care unit (NICU) are common in some primary hospitals. This study aimed to investigate the noise in the NICU on auditory system and intelligence development in premature infants. METHODS: One hundred premature infants with respiratory distress syndrome who needed mechanical ventilation therapy were randomly divided into observation and control groups according to the use of earmuffs. The duration of mechanical ventilation therapy lasted for 2 to 15 days in the two groups. After weaning from mechanical ventilator, the auditory brainstem response, cranial B-ultrasonography, and the intelligence development assessment were performed. RESULTS: The percentage of total (23% vs 47%) and mild hearing loss (15% vs 35%) in the observation group was significantly lower than that in the control group (P<0.05) 2 to 3 days after weaning from mechanical ventilator. The incidence of periventricular hemorrhage intraventricular hemorrhage (PVH-IVH) or periventricular leukomalacia (PVL) in the observation group was significantly lower than that in the control group (21% vs 42%; P<0.05). The intelligence development assessment performed in the first 6 and 12 months of life showed that the mental development index and the psychomotor development index in the observation group were much higher than those in the control group (P<0.05). CONCLUSIONS: The noise in the NICU can result in mild hearing loss and retardation of intelligence development and increase the incidence of PVHIVH and PVL in premature infants. The use of earmuff may reduce the adverse events.［Chin J Contemp Pediatr, 2009, 11 (12):976-979］