不同刺激模式下人工耳蜗使用者EABR的研究  

EABR in cochlear implant users by different stimulation modes

作　　者：肖琨[1] 张学渊[1] 陈小宏[1] 黄青平[1] 

机构地区：[1]重庆第三军医大学附属西南医院耳鼻咽喉-头颈外科,重庆400038

出　　处：《中华耳科学杂志》2008年第1期76-82,共7页Chinese Journal of Otology

摘　　要：目的研究不同刺激模式对人工耳蜗植入术后电诱发听觉脑干反应(EABR)波形和阈值的影响。方法对9名Nucleus 24M人工耳蜗植入患者术后分别测试电极E3,E10,E20(分别代表蜗底、蜗中、蜗顶)在不同刺激模式(MP1+2、MP1、MP2、BP+1、CG)下的EABR阈值,比较分析强度为200～255电流级(currentlev-el,CL;约阈上30电流级)刺激时各电极在五种刺激模式下引出的EABRⅢ波和Ⅴ波引出率、潜伏期及其幅值。结果(1)Ⅲ波总检出率为44.44%,电极3,10,20的Ⅲ波检出率分别为22.22%,42.22%,68.89%,蜗顶较高(!2=58.2,df=4,P﹤0.01)。单极模式下的Ⅲ波检出率较高(!2=28.5,df=4,P﹤0.01)。(2)MP2刺激模式下Ⅲ波平均潜伏期为2.06ms,电极3,10,20间无统计学差异(P=0.299﹥0.05)。(3)MP1+2,MP1,MP2,BP+1,CG模式下EABRⅤ波检出率分别为96.3%,94.4%,96.3%,14.8%,33.3%,单极模式下(MP1+2,MP1,MP2)的Ⅴ波检出率较高(!2=75.667,df=4,P<0.005)。三个电极位点间无明显差别(!2=2.600,df=2,P=0.273>0.05)。(4)在蜗顶诱发EABR的电刺激阈值较低,E20和E3(P=0.001<0.01)、E20和E10(P=0.002<0.01)均存在统计学差异。单极、双极、共地模式的阈值依次升高,而单极模式MP1、MP2、MP1+2之间无统计学差异。(5)电极3,10,20的Ⅴ波潜伏期分别为4.09±0.16ms,4.02±0.19ms,3.70±1.21ms,蜗顶的Ⅴ波潜伏期短于蜗中段和蜗底(P=0.001<0.01,P=0.001<0.01)。刺激模式间的差别无统计学意义(P=0.309>0.05)。(6)EABRⅤ波振幅在电极位点间(P=0.06>0.05)及刺激模式间(P=0.093>0.05)均无统计学差异。但个体差异大,可认为蜗顶和单极刺激模式倾向于获得较大的振幅。(7)本实验同时采用了同侧和对侧记录,发现同侧记录的波形和对侧记录的波形相似,部分反而更清晰,波形分化更好,随刺激强度的下降Ⅴ波消失稍晚。结论人工耳蜗植入术患者术后单极刺激下易检测出EABR波形,检出率高,波形分化较好,波幅大,而采用双极及共地模式EABR阈值较高或难以Objective To investigate the impact of stimulation modes on electrically evoked auditory brainstem response （EABR）. Methods Three electrodes in 9 Nucleus 24M cochlear implant users, along the electrode array from the base towards the apex, were stimulated for EABR registration. EABRs were recorded in MP1＋2, MP1, MP2, BP＋1, CG stimulation modes respectively. The detection rates, peak latencies and amplituds of EABR wave Ⅲ and Ⅴ were compared between the 3 electrodes, as well as the different stimulation modes. Results （1） The a average detection rates of the wave Ⅲ was 44.44%, and it was 22.22%, 42.22% and 68.89% in E3, E10 and E20, respectively, indicating a higher rate in the apex （ X^2= 58.2, df= 4, P 〈 0.01） and in the monopolar mode （X^-2= 28.5, df= 4, P〈 0.01）. （2） The average latency of wave Ⅲ was 2.06 ms with no statistical difference between the 3 electrodes （P=0.299〉0.05）. （3） The EABR wave Ⅴ detection rate was 96.3%, 94.4%, 96.3%, 14.8% and 33.3% in MP1＋2, MP1, MP2, BP＋1 and CG mode, resoectively. The detection rate in the MP mode was higher than others （ X^2 = 75.667. df = 4, P 〈 0.005 ）. There was no statistical difference in the detection rate among the three electrodes （X^2 = 2.600, df= 2, P = 0.273 〉 0.05）. （4） EABR threshold was lower in the apex, with difference between E20 and E3 （P = 0.001 〈 0.01 ）, as well as between E20 and E10 （P = 0.002 〈 0.01）. The threstholds rose in the order of the MP, BP and CG mode. No difference existed between MP1, MP2 and MP1 ＋2. （5） The wave Ⅴ latency of E3, E10 and E20 was 4.09±0.16 ms, 4.02 ± 0.19 ms and 3.70 ± 1.21 ms, respectively, with the shortest latency in the apex （P = 0.001 〈 0.01, P = 0.001 〈 0.01 ）. There was no statistical difference among the stimulation modes（P= 0.309〉0.05）. （6） Wave V amplitude varied little among the electrodes （P = 0.06 〉 0.05） and the stimulation modes （P=0.093 〉 0.05）. （7） Ipsilateral and contralateral r

关 键 词：电诱发听觉脑干反应 人工耳蜗 阈值 刺激模式 

分 类 号：R318.18[医药卫生—生物医学工程] R764.04[医药卫生—基础医学]