神经反应遥测用于人工耳蜗植入患儿术后康复效果预估和编程的意义  

Instructions of Neural Response Telemetry for Prediction of the Rehabilitation Effects and Mapping in Children Cochlear Implant

作　　者：杨烨[1] 陈杰[1] 钱晓云[1] 曹永晖[2] 戴艳红[1] 高下[1] 

机构地区：[1]南京大学医学院附属鼓楼医院耳鼻咽喉头颈外科,南京210008 [2]南京大学医学院附属鼓楼医院医学信息科

出　　处：《听力学及言语疾病杂志》2015年第5期522-526,共5页Journal of Audiology and Speech Pathology

基　　金：江苏省临床医学科技专项(BL2012036);南京市医学科技发展重点项目(ZKX13027);南京市科技发展计划(201303003)联合资助

摘　　要：目的：探讨人工耳蜗植入术后神经反应遥测（neural response telemetry ，NRT ）阈值变化规律与行为T值、C值的相关性，以及NRT波形引出与否对于判断学龄前儿童人工耳蜗植入术后康复效果的预估作用。方法收集159例资料完整的人工耳蜗植入患儿（2岁8个月～5岁9个月）开机时、开机后1个月、6个月、12个月时1、6、11、16、22号五个电极的NRT阈值，使用方差分析比较各电极在不同时期 NRT阈值的变化；使用pearson相关和回归分析，比较开机后1年时上述电极的行为 T值、C值与开机时相应电极NRT阈值的相关性；使用有意义听觉整合量表（meaningful auditory integration scale ，MAIS）评估159例患儿康复效果，并对所有患儿进行声场测试获得平均助听听阈，依据术中、术后是否引出NRT波形进行分组，使用方差分析比较各组患儿康复效果。结果1、6、11、16、22号各电极四个时间点的 NRT阈值两两比较差异均无统计学意义（P＞0．05）；开机时NRT阈值与术后1年时的行为T值、C值之间均具有正相关性（P＜0．005），但相关性较弱；术中、术后均未引出NRT波形组的MAIS得分及平均助听听阈均较其他三组（术中、术后均引出组，术中部分引出、术后均引出组，术中未引出、术后均引出组）差（P＜0．01），而其他各组间两两比较差异均无统计学意义（P＞0．05）。结论各电极NRT阈值自开机时至术后1年基本保持稳定，NRT阈值与行为T值、C值之间具有弱的正相关性，但准确性不及行为法所测值，仍需尽早过渡为行为法；术后NRT波形引出与否对康复效果的预估具有重要意义，而术中NRT波形引出与否对预估康复效果的参考价值不大。Objective To study the stability of NRT threshold and the correlation between NRT threshold and the value of behavior T ,C in order to instruct mapping in infant cochlear implant ,and to study whether the elic‐itation of NRT waveform can be applied to determine the effects of rehabilitation .Methods There were 159 cases with complete information in data in this study .150 out of the 159 cases coincided with the study requirements of the changes and correlation .We had collected the NRT thresholds of the electrodes of No .1 ,6 ,11 ,16 ,22 in switch-on ,one month after switched -on ,half a year and one year after switched -on .The analysis of variance method was adopted to compare the threshold changes of each electrode in different stages .We had collected the values of behavior T ,C in one year after switched -on .Pearson regression analysis was used to compare the correlation be‐tween NRT threshold in switch -on and this value of behavior T ,C .We applied MAIS assessment scale to make a questionnaire for all 159 patients during the follow -up at one year after switched -on .We had gathered the scores in three aspects ,the average score in questionnaire and the average hearing threshold of every child .All children were divided into four groups according to whether the elicitation of NRT waveform during - operation ,post-op‐eration .Results Regarding the NRT threshold ,there was no significant difference in the pairwise comparison of four time points（P〉0 .05） .There was positive correlation between NRT threshold and behavior T ,C（P〈0 .01） , but the correlation was wake .The group with no waveform on the during -operation and post -operation had sig‐nificant differences with the other groups in all scores and average hearing threshold （p〈0 .01） .And there was no statistical significance among the other three groups （P〉 0 .05） .Conclusion The NRT threshold remains steady from switched -on .A positive correlation exists between NRT threshold and the actual T ,C value .The NRT threshol

关 键 词：人工耳蜗植入 神经反应遥测 儿童 调机 康复 

分 类 号：R764.5[医药卫生—耳鼻咽喉科]