人工耳蜗植入术中电刺激中潜伏期听觉诱发电位的检测  

Measurement of electrical evoked middle latency response in cochlear implantation operation

作　　者：王斌[1] 曹克利[1] 王轶[1] 路远[1] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院耳鼻咽喉科,100730

出　　处：《中华耳鼻咽喉头颈外科杂志》2012年第3期196-201,共6页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

摘　　要：目的建立人工耳蜗植入术中电刺激中潜伏期听觉诱发电位（electrical evoked middlelatency response，EMLR）的检测方法，为进一步评估植入者听觉传导通路及高位听觉反应的特点奠定基础。方法20例人工耳蜗植入者，其中语前聋14例，语后聋6例，全部使用Cochlear公司Nucleus C124R（CA）人工耳蜗。术中将言语处理器与计算机接口及听觉诱发电位仪触发端口连接，电极植入后，选取第3号电极，先常规进行电刺激听神经复合动作电位（electrically evoked auditory nervecompound active potentials，ECAP）测试初步了解听神经功能状态，然后进行EMLR检测。选择电刺激听陛脑干反应（electrical auditory brainstem response，EABR）模式，采用单极刺激，双相交替脉冲电流方波，脉宽50～100μs，强度（电流级，currentlevel，CL）由ECAP阈值上20cL起，以5CL为步长递减或递增，听觉诱发电位仪记录EMLR波形。对ECAP阈值与EMLR阈值进行相关性分析。另外选择6名听力正常健康受试者，行声刺激中潜伏期听觉诱发电位（auditorymiddlelatencyresponse，AMLR）测试，作为EMLR波形和潜伏期的声刺激对照。结果6例听力正常受试者均可记录到AMLR波形，平均反应阈为（12．54-8．6）dBnHL，接近纯音测听阈值（10．8-4-7．3）dBHL。20例人工耳蜗植入者均可记录到EMLR波形，与AMLR波形相似，但各波潜伏期和波问期缩短，波幅变化不大；语前聋较语后聋总体上波幅小，潜伏期长。EMLR平均阈值为（140．55-4-9．92）CL，低于ECAP的平均阈值（160．75±13．34）CL，差异具有统计学意义（t=10．467，P〈0．01）；二者阈值之间呈正相关（r=0．763，P〈0．01）。结论人工耳蜗植入术中可成功记录到EMLR波形，其阂值较ECAP低，可以作为判断植入者中枢高位听觉传导功能的客观检查。Objective To establish the method of conducting electrical evoked middle latency response （EMLR） monitoring in cochlear implantation operation and further to assess the neural response of auditory pathway under electrical stimulation. Methods Twenty cases of cochlear implantation subjects were investigated in this study. Fourteen cases were pre-lingual deaf and 6 were post-lingual deaf. The surface recording electrodes were placed on the patients under general anesthesia, with language processor connected to the triggering port of the auditory evoked potential device. After the electrode was implanted, the electrode No. 3 was selected to conduct. The electrically evoked auditory nerve compound active potentials（ECAP） were firstly tested in all patients, thereafter the EABR mode was selected, and the stimulation parameters were changed to EMLR mode with monopole biphasic, ahemation stimulation, pulse width from 50 to 100 Ixs, the stimulation intensity decreased or increased from 20 CL above the strength of the ECAP threshold to the reaction threshold with a step of 5CL . To evaluate the correlation between the ECAP thresholds and EMLR, another 6 cases of normal hearing healthy subjects were recruited to record their short-sound evoked auditory middle-latency response （AMLR）, as the control of morphology and latency of MLR by electrical stimulation. Results The typical AMLR waveforms could be recorded by the composition of five waves in the 6 cases of normal hearing healthy subjects, with an average responsethreshold of （ 12.5 -＋ 8.6） dBnHL, close to the behavioral audiometric threshold（ 10.8 ~ 7.3 ） dBHL. The EMLR waveforms could be recorded in 20 patients, which was similar to the AMLR waveforms. However, the wave latency and wave interval silortened. There were lower volatility and longer latency in pre-lingual deaf than post-lingual deaf. The EMLR threshold（ 140.55 ＋-9.92 ）CL was significantly lower than the ECAP threshold （ 160.75 _＋ 13.34 ） CL （ t = 10. 467, P 〈 0.01 ）

关 键 词：耳蜗植入术 诱发电位 听觉 电刺激 

分 类 号：R764[医药卫生—耳鼻咽喉科]