宽频声导抗在无创颅内压监测中的应用初探  

Application ofWideband Acoustic Immittance in Noninvasive Intracranial Pressure Monitoring

作　　者：木怡 林欢 岳昱宏 乔月华 蒋雯 MU Yi;LIN Huan;YUE Yuhong;QIAO Yuehua;JIANG Wen(Department of Otolaryngology,the Affiliated Hospital of Xuzhou Medical University,Xuzhou 221000,China;不详)

机构地区：[1]徐州医科大学附属医院耳鼻咽喉科,徐州221000 [2]徐州医科大学医学技术学院 [3]江苏省人工听觉工程实验室 [4]徐州医科大学第二临床医学院

出　　处：《中华耳科学杂志》2024年第1期130-135,共6页Chinese Journal of Otology

基　　金：江苏省研究生科研与实践创新计划项目(KYCX23_2940)。

摘　　要：目的通过分析不同姿势下颅内压(ICP)变化对中耳能量传递的影响,探寻一种基于中耳功能的无创ICP监测指标。方法于2023年3月—6月在徐州医科大学附属医院耳鼻咽喉科招募的听力正常,无耳部疾病史的高校在读青年受试者30例(60耳),其中男性12例,女性18例。年龄20~24岁,平均年龄(21.17±1.23)岁。受试者通过226 Hz声导抗、纯音测听等检查后,分别以端坐位、低头位和仰卧位在环境压力下进行宽频声导抗测试,选取1/3倍频程(共16个频率点)在不同体位下的声能吸收率(energy absorbance,EA)、声能反射率(energy reflectance,ER)、透射率(pow transmittance,pow T)与阻抗幅值(Impedance magnitude)进行分析。结果经广义估计方程分析,EA、ER与pow T在630、794、1000、4000 Hz频率点由于体位的改变,差异有统计学意义(P<0.05),Zamg除3175、6000 Hz频率点无统计学差异,在其余14个频率点均存在统计学差异(P<0.05)。经两两比较,端坐位和低头位,WAI参数只有Zamg在1000 Hz和1260 Hz存在统计学差异(P<0.05)。但端坐位和仰卧位EA、ER与pow T在4000、5040 Hz存在统计学差异(P<0.05);低头位和仰卧位的EA、ER与pow T在中频段(500~1000 Hz)存在统计学差异(P<0.05);Zamg在大部分频率点均存在统计学差异(P<0.05)。结论宽频声导抗能够反应不同姿势下ICP的生理状态变化,且具有频率特异性。因此,这种无侵入性、更便捷的中耳测试方式为监测ICP提供可能。Objective To report non-invasive intracranial pressure(ICP)monitoring based on middle ear function reflecting middle ear energy transmission in different postures.Methods Thirty young college students(60 ears)with normal hearing and no history of ear diseases were recruited from March to June 2023 by the department of otolaryngology at the affiliated hospital of Xuzhou Medical University,including 12 males and 18 females,aged from 20 to 24 years(21.17±1.23 years).After otoscopy,226 Hz acoustic immittance and pure tone audiometry,the subjects underwent wideband acoustic immittance testing under ambient pressure in sitting,head-down and supine positions.Results EA,ER and pow T at 630,794,1000 and 4000 Hz showed body position associated differences(P<0.05).Zamg showed no sta body position associated differences at 3175 and 6000 Hz,but at all remaining 14 frequency.In paired comparison,Zamg showed differences between sitting and head-down positions showed at 1000 and 1260 Hz(P<0.05);EA,ER and pow T showed differences between sitting and supine positions at 4000 and 5040 Hz(P<0.05);EA,ER and pow T showed differences between head—down and supine positions at middle frequencies(500-1000 Hz,P<0.05);Zamg showed differences at most frequencies(P<0.05).Conclusion Wideband immittance reflects physiological changes of intracranial pressure from different postures in a frequency specific manner.This non-invasive and convenient middle ear function test provides a possibility for ICP monitoring.

关 键 词：颅内压 宽频声导抗 中耳能量传递 

分 类 号：R764.04[医药卫生—耳鼻咽喉科]