先天性聋人工耳蜗植入儿童皮层听觉诱发电位的研究  

Cortical auditory evoked potentials in congenital hearing impaired children with cochlear implants

作　　者：卢伟[1] 陈丽丽[1] 鲁倩[1] 孙淑萍[1] 雷一波[1] 陈雪清[2] 米思 莫玲燕[2,4] 

机构地区：[1]郑州大学第一附属医院耳科,450052 [2]首都医科大学附属北京同仁医院北京市耳鼻咽喉科研究所耳鼻咽喉头颈科学教育部重点实验室(首都医科大学),100730 [3]北京市通州区人工耳蜗康复中心,101100 [4]北京和睦家医院耳鼻咽喉科

出　　处：《中华耳鼻咽喉头颈外科杂志》2016年第4期241-246,共6页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：国家教育部留学回国人员科研启动基金（教外司留[2007]24号）;河南省卫生科技重大攻关项目（豫财办教[2010]103号）;河南省医学科技攻关计划项目（河南省卫生厅[2013]03049号）;首都卫生发展科研专项（首发2011-1017-01）

摘　　要：目的 通过对先天性聋人工耳蜗植入儿童皮层听觉诱发电位（cortical auditory evoked potential,CAEP）的研究,探讨中枢听觉发育与人工耳蜗植入年龄之间的关系.方法 5岁前植入人工耳蜗的先天性聋患儿110例,测试时年龄12～80个月,其人工耳蜗使用时间从刚开机到48个月.声场下以65 dBSPL的/m/、/t/、/g/为测试声,进行CAEP测试,记录其P1、N1及P2波.分析各波的引出率、人工耳蜗植入年龄以及使用时间与P1波潜伏期的关系.结果 P1波的总体引出率为66.4％,N1波为15.5％,P2波为12.7％;P1波的引出率明显高于N1波（x^2=228.542,P=0.00）和P2波（x^2=257.438,P=0.00）,差异具有统计学意义./m/、/t/、/g/等三种刺激声的P1波引出率分别为64.1％、66.9％和68.3％,差异无统计学意义（x^2=0.589,P=0.75）;三种刺激声之间P1的潜伏期（P=0.22）和幅度（P=0.09）,差异均无统计学意义.植入年龄≤42月龄组P1潜伏期进入与年龄相当的正常值范围的百分比（95.3％）明显高于＞ 42月龄组（66.7％）,差异具有统计学意义（P=0.02）.在42月龄前植入人工耳蜗的儿童中,耳蜗使用时间分别为1年、2年、3年和4年的各组之间,在进入年龄相当的正常P1潜伏期范围的百分比上,差异无统计学意义（P=1.00）.结论 先天性聋患儿42月龄前植入人工耳蜗,其听觉中枢更有可能实现正常发育,而且一经植入使用,即可迅速发育达到正常听力的水平.Objective By investigating the auditory cortical evoked potential in congenital hearing impaired children with cochlear implants,the association between central auditory development and the age of implantation was studied.Methods P1-N1-P2 were recorded in 110 profound hearing impaired children,aged from 12 to 80 months old and being implanted with cochlear implants before the age of 5 years.Their implant using time ranged from just at the switch-on to 48 months.The stimuli were /m/,/t/,/g/,presented at 65 dB SPL in sound field.The presence rate of each wave was obtained and the relationship between P1 latency and implant age,the time of speech processor switch-on were analyzed.Results The presence rate of P1,N1 and P2 was 66.4%,15.5% and 12.7%,respectively.The presence of P1 was significantly higher than that of N1 （x^2 =228.542,P =0.00） and P2 （x^2 =257.438,P =0.00）.There was no significant difference of P1 presence rate elicited by/m/,/t/ and /g/（64.1%,66.9% and 68.3%,x^2 =0.589,P =0.75）.There existed no significant difference either among P1 latency （P =0.22） or amplitude（P =0.09） elicited by/m/,/t/ and/g/.There was significant difference between the implant age before and after 42-month-old regarding the proportion that entered the age-appropriate normal P1 latency range（P =0.02）.No significant difference was found among groups of implant using time of 1,2,3 and 4 years in aspect of the proportion that entered the age-appropriate normal P1 latency range （P =1.00）.Conclusions Compared with implanted after the age of 42-month-old children with prelingual hearing impairment younger than 5 years old,the ones implanted before 42-month-old have more chance for normal development for central auditory system.Once implanted before 42-month-old,the cortical auditory system restored its normal development as early as 1 year after implantation.

关 键 词：听觉丧失 诱发电位 听觉 耳蜗植入术 儿童 

分 类 号：R764.9[医药卫生—耳鼻咽喉科]