小儿专科医院开展人工耳蜗植入手术的优势  

The comparison of cochlear implantation in children and general hospitals

作　　者：李晓东[1] 沈培[2] 姚红兵[3] 孙越峰[4] 韩富根[5] 林建云[6] 张道行[7] 

机构地区：[1]河北省唐山市妇幼保健院耳鼻咽喉科,063000 [2]天津市儿童医院耳鼻咽喉科 [3]重庆医科大学附属儿童医院耳鼻咽喉科 [4]浙江大学医学院附属儿童医院耳鼻咽喉科 [5]河南省郑州市儿童医院耳鼻咽喉科 [6]云南省昆明市儿童医院耳鼻咽喉科 [7]首都医科大学附属北京友谊医院耳鼻咽喉科

出　　处：《中国中西医结合耳鼻咽喉科杂志》2009年第4期181-184,211,共5页Chinese Journal of Otorhinolaryngology in Integrative Medicine

摘　　要：目的通过本组6家小儿专科医院开展人工耳蜗植入手术的临床工作,讨论小儿专科医院开展人工耳蜗植入手术的优势。方法从1998年5月～2009年3月11年间,本组6家小儿专科医院耳鼻咽喉科共开展了103例人工耳蜗植入手术。术前信息:全部为双耳重度和极重度感音神经性聋,年龄8.5个月～10.2岁,平均年龄为3.8岁,全部为语前聋患儿。术前进行听力学评估、发育和智力评估、影像学评估、人工耳蜗植入适应证的评估。术前进行全麻风险的评估。进行与综合性医院开展人工耳蜗植入手术的优势比较,包括:①术前评估水平,②术中麻醉风险,③人工耳蜗植入手术结果,④围手术期护理和并发症处理水平。结果①术前评估:术前视觉强化行为测听检查:103例查出有残留听力49例,平均听力98dB,余54例无残留听力。畸变产物耳声发射检查:103例均未引出耳声发射。听觉脑干诱发电位、40Hz、多频稳态诱发电位检查:引出波形41例,未引出波形62例。术前影像学检查:颞骨CT检查103例中正常颞骨形态84例,内耳畸形19例,其中双耳大前庭导水管畸形11例、Mondini畸形7例、前庭与外半规管共同腔畸形1例。脑常规MRI检查,正常98例、脑白质轻度异常5例。行为和智力测试:格雷费斯智力测试>86分99例、<86分4例。术前检查结果与综合性医院检查结果比较,无显著差异。②术中麻醉风险:全麻插管、拔管中出现心电、氧、二氧化碳监测问题、气管支气管痉挛并发症0例,综合性医院发生率为0.37%,有明显的安全优势。③人工耳蜗植入手术结果:103例手术均成功,与综合性医院比较,无明显差异。④围手术期护理与并发症的处理:103例术前常规静脉采血、术中、术后常规建立静脉通道未出现失败,综合性医院出现静脉采血、建立静脉通道失败率约5%左右,小儿专科医院具有显著优势。未见明显并发症和并发症处Objective To review and summarize the advantages of cochlear implantation performed in children hospital. Methods： 103 patients with severe to profound sensorineural hearing loss were received cochlear implantation fi＇om May1998 to March 2009, the children＇s age range from 8.5 months to 10.2 years with an average age of 3.8 years, the peri-operation advantage of children hospitals were compared with those of general hospitals. Results The results of preoperation examination were similar with those of general hospital ,the anesthesia risks is lesser than that of general hospital obviously, the difference of surgical outcomes is not significant, and the children have more experiences in perioperration nursing and complications treatment. Conclusion Preoperation evaluation, anesthesia and perioperation nursing in children hospitals have more advantages than in the general hospitals, but the doctors of children hospital have less otosurgical experiences may preclude the program of cochlear implantation.

关 键 词：人工耳蜗植入 小儿专科医院 优势 

分 类 号：R764.9[医药卫生—耳鼻咽喉科]