Hall J W
Division of Hearing and Speech Sciences, School of Medicine, Vanderbilt University, Nashville, Tennessee 37232-2559.
Am J Otol. 1988 Dec;9 Suppl:36-46.
In recent years, the role of auditory evoked responses (AERs) in the intensive care unit (ICU) setting has expanded dramatically for both pediatric and adult brain-injured patient populations. AERs have unique value in early identification and evaluation of peripheral auditory dysfunction that can result directly from head trauma or as a consequence of intensive medical therapy (such as prolonged intubation and ototoxic drugs). AERs can also be applied in evaluating and monitoring neurologic status during the acute period following a severe brain injury, similar to their common intraoperative use as a neurophysiologic monitor. This paper reviews factors influencing measurement of AERs in the ICU, including the effect of (1) intensive medical therapy (e.g., neuromuscular blockers, sedatives, barbiturates, aminoglycosides, and loop diuretics); (2) coma; and (3) computed tomography confirmed temporal bone fracture. The rationale for monitoring neurologic status with AERs in this setting is presented and supported with original group data. Important points are illustrated with selected case reports.
近年来，对于儿科和成年脑损伤患者群体而言，听觉诱发电位（AERs）在重症监护病房（ICU）中的作用已大幅扩展。AERs在早期识别和评估外周听觉功能障碍方面具有独特价值，这种功能障碍可能直接由头部创伤引起，也可能是强化药物治疗（如长时间插管和使用耳毒性药物）的结果。AERs还可用于评估和监测严重脑损伤急性期的神经状态，这与它们在术中作为神经生理监测手段的常见应用类似。本文综述了影响ICU中AERs测量的因素，包括（1）强化药物治疗（如神经肌肉阻滞剂、镇静剂、巴比妥类药物、氨基糖苷类药物和袢利尿剂）；（2）昏迷；以及（3）计算机断层扫描证实的颞骨骨折的影响。本文阐述了在此背景下使用AERs监测神经状态的基本原理，并提供了原始分组数据作为支持。通过选定的病例报告说明了要点。
