人工耳蜗术后患儿早期听觉康复规律及影响因素的动态研究  

Longitudinal Study on Early Pre-lingual Auditory Development of Children after Cochlear Implantation and Its Influencing Factors

作　　者：孔维丽[1] 李梅[1] 罗学翀 马兰[1] 吴君昊 顾海玲 郑芸[1] KONG Weili;LI Mei;LUO Xuechong;MA Lan;WU Junhao;GU Hailing;ZHENG Yun(Department of Otorhinolaryngology-Head and Neck Surgery,West China Hospital,Sichuan University,Chengdu 610041)

机构地区：[1]四川大学华西医院耳鼻咽喉头颈外科,成都610041

出　　处：《中华耳科学杂志》2021年第5期781-786,共6页Chinese Journal of Otology

摘　　要：目的研究双耳极重度语前聋患儿人工耳蜗植入(Cochlear Implant,CI)术后2年的早期语前听能(Early Pre-lingual Auditory Development,EPLAD)发育特点并探索最佳预测公式,同时探讨不同时间点影响EPLAD因素的变化。方法在七个不同时间点用婴幼儿有意义听觉整合量表(Infant-toddler Meaningful Auditory Integration Scale,IT/MAIS)测试86例CI儿童的EPLAD。选用spline函数将所有患儿7次得分的总体趋势形成真实的平滑曲线,并用非线性拟合找到最佳预测函数。多变量线性混合回归模型用于探索影响患儿术前、开机后6月、12月、24月EP-LAD的因素。结果儿童CI植入第一年,IT/MAIS得分提高了67.53%,第二年较第一年继续提高了15.23%,在24个月时基本达到满分。三次函数为最佳拟合曲线,拟合函数为:Y=16.14+10.89 X-0.54 X2+0.01 X3(0≤X≤24,R2=0.99)。术前对CI儿童的EPLAD影响因素包括术前听阈、术前言语模仿能力、术前佩戴助听器;术后半年及一年的影响因素为术前言语模仿能力、术后对侧助听器佩戴;术后两年的影响因素为术后对侧助听器佩戴、术后听觉言语康复训练时间。结论儿童CI植入后两年内IT/MAIS得分持续上升,但上升趋势先快后慢,并在开机后第24个月达到满分。CI术后患儿EPLAD的影响因素并不是固定不变,而是随着时间的不同呈动态变化。Objective To study the trajectory of early pre-lingual auditory development(EPLAD)in children with profound prelingual deafness after cochlear implantation(CI)and identify the best prediction formula and factors affect-ing EPLAD at different time points.Methods EPLAD was tested with IT/MAIS in 86 CI children at seven different time points.A spline function was used to generate a smooth curve for the overall trend over the 7 time points,with the best prediction function identified via nonlinear fitting.A multivariable linear mixed regression model was used to ex-plore factors affecting EPLAD before operation and at 6 months,12 months and 24 months after activation.Results IT/MAIS scores increased by 67.53%in the first year and 15.23%in the second year compared with the first year,reaching full marks at 24 months.The cubic function was the best fitting curve,and the fitting function was Y=16.14+10.89 X-0.54 X2+0.01 X3(0≤X≤24,R2=0.99).The factors influencing EPLAD in CI children before operation included preop-erative hearing threshold,speech imitation ability and use of hearing aids.Factors influencing EPLAD at six months and one year after operation were preoperative speech imitation ability and contralateral hearing aid use.Factors influencing EPLAD at two years after operation were use of contralateral hearing aids and the time of auditory rehabilitation train-ing.Conclusion IT/MAIS scores continue to rise in children within two years after CI,although fast first followed by a slowing down before reaching full marks at the 24th month after activation.Factors influencing EPLAD in children af-ter CI dynamically change with time.

关 键 词：人工耳蜗 早期语前听能 双耳极重度聋 影响因素 婴幼儿有意义听觉整合量表 

分 类 号：R764[医药卫生—耳鼻咽喉科]