脑白质异常的语前聋患儿人工耳蜗植入术后康复效果分析

发布时间：2018-04-04 21:19

本文选题：脑白质异常　切入点：双侧极重度感音神经性聋　出处：《福建医科大学》2016年硕士论文

【摘要】：目的:通过对接受人工耳蜗植入术的语前聋患儿的术后听觉能力及言语能力进行评估,研究分析脑白质异常的双侧极重度感音神经性聋的语前聋患儿在人工耳蜗植入术后的康复效果。方法:对福建省某三甲医院自2014年1月至2015年1月之间行人工耳蜗植入术的11例伴脑白质异常(研究组)及18例脑组织正常(对照组)的双侧极重度感音神经聋的语前聋患儿进行回顾性的分析研究。所有患儿术前均行病史调查、听力学检查、影像学检查及常规检查。所有患儿手术均由福建省某三甲医院耳鼻喉科同一人完成,全部选择右侧患耳植入人工耳蜗,术中与术后均无并发症,均于术后1个月开机,所有患儿术后均以当地康复中心言语训练为主,家庭言语训练为辅。采用听觉行为分级标准(CAP)和言语可懂度分级标准(SIR)作为评估标准,在患儿术后6个月及12个月时,对患儿生活环境中的有直接接触的家庭成员进行电话随访,评估患儿的听觉能力及言语能力,对研究组及对照组在两个时间点的指标均数比较采用t检验,p0.05为差异有统计学意义。结果:研究组患儿术后6个月时CAP平均分级为2.41±0.47级,CAP分级均在2-3级之间,而对照组患儿术后6个月时CAP平均分级为3.28±0.45级,CAP分级则大部分位于3-4级之间。研究组患儿术后6个月SIR平均分级为1.27±0.44级,仅3例患儿的SIR分级能够到达2级,其余均为1级,而对照组患儿术后6个月SIR平均分级为1.89±0.31级,仅2例为1级,其余均为2级。研究组患儿术后12个月CAP平均分级为4.00±0.43级,仅1例分级为3级,1例为5级,其余均为4级,对照组患儿术后12个月CAP平均分级为4.22±0.63级,仅2例为3级,有6例可达5级,其余均为4级。研究组患儿术后12个月SIR平均分级为2.36±0.48级,均在2-3级,对照组患儿术后SIR平均分级为2.44±0.50级,均在2-3级。术后6个月CAP平均分级两组有统计学差异(t=4.983,P0.05),术后6个月SIR平均分级两组有统计学差异(t=4.371,P0.05);术后12个月CAP平均分级两组无统计学差异(t=1.033,P0.05),术后12个月SIR平均分级两组无统计学差异(t=0.434,P0.05)。结论:在术前MRI检查里提示脑白质异常的双侧极重度感音神经性聋且无明显的神经系统症状及精神异常等情况的语前聋儿童,其人工耳蜗植入术后康复效果与脑白质正常的患儿无明显差异。
[Abstract]:Objective: to evaluate the hearing and speech ability of children with prelingual deafness after cochlear implantation.The effects of cochlear implantation in children with bilateral extremely severe sensorineural deafness with abnormal white matter were analyzed.Methods: from January 2014 to January 2015, 11 patients with white matter abnormalities and 18 patients with normal brain tissue (control group) underwent cochlear implantation from January 2014 to January 2015 in a third Class A Hospital in Fujian Province, with bilateral extremely severe sensorineural deafness.A retrospective study was conducted in children with prelingual deafness.All children were examined with history, audiology, imaging and routine examination before operation.All the children underwent the operation by the same person in the department of otolaryngology of the third Class A Hospital in Fujian Province. All the patients were selected for cochlear implantation in the right ear. There were no complications in the operation and the operation was performed 1 month after operation.All the children were trained mainly by local rehabilitation center and supplemented by family language training.Auditory behavior scale (CAP) and speech intelligibility scale (SIRs) were used as the evaluation criteria. The family members who had direct contact with each other were followed up by telephone at 6 and 12 months after operation.To evaluate the hearing ability and speech ability of the children, there was a significant difference between the study group and the control group by using t test (p0.05) to compare the mean of indexes at two time points.Results: in the study group, the average CAP grade was 2.41 卤0.47 grade and 2-3 grade at 6 months after operation, while in the control group, the average CAP grade was 3.28 卤0.45 grade and 3.28 卤0.45 grade respectively.In the study group, the average SIR grade was 1.27 卤0.44 at 6 months after operation. The SIR grade of the 3 cases could reach grade 2 and the rest were all grade 1. In the control group, the average SIR grade was 1.89 卤0.31 at 6 months after operation, only 2 cases were grade 1, and the rest were all grade 2.The rest are of grade 4.The average SIR grade was 2.36 卤0.48 grade (2-3 grade) in the study group and 2.44 卤0.50 grade (2.44 卤0.50) in the control group.鏈悗6涓湀CAP骞冲潎鍒嗙骇涓ょ粍鏈夌粺璁″宸紓(t=4.983,P0.05),鏈悗6涓湀SIR骞冲潎鍒嗙骇涓ょ粍鏈夌粺璁″宸紓(t=4.371,P0.05);鏈悗12涓湀CAP骞冲潎鍒嗙骇涓ょ粍鏃犵粺璁″宸紓(t=1.033,P0.05),鏈悗12涓湀SIR骞冲潎鍒嗙骇涓ょ粍鏃犵粺璁″宸紓(t=0.434,P0.05).Conclusion: preoperative MRI examination suggested that children with bilateral extremely severe sensorineural deafness with abnormal white matter and no obvious nervous system symptoms and mental abnormalities were found to have prelingual deafness.There was no significant difference between the rehabilitation effect of cochlear implant and that of normal white matter.
【学位授予单位】：福建医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R764.9

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