大脑认知功能在人工耳蜗植入术后疗效评估中的应用研究

发布时间：2018-03-17 18:31

本文选题：人工耳蜗植入　切入点：语前聋　出处：《广西中医药大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:通过对重度或极重度感音神经性聋中语前聋患者人工耳蜗植入后听觉言语及大脑认知功能康复效果进行评估,分析听觉获得后人工耳蜗对患者大脑认知功能的影响及不同植入年龄患者大脑加工信息的变化的特点,从而为语前聋患者人工耳蜗植入和术后科学性的康复训练提供参考依据。方法:1、采用听觉行为分级(categories of auditory performance,CAP)和言语可懂度分级(speech intelligibility rating,SIR)对62例语前聋患者人工耳蜗植入术后进行问卷调查随访,对其听觉感知和言语康复能力进行评估。2、应用数字化远程认知评估系统(Electronic cognitive assessment system,E-CAS)对34例5岁-17岁的语前聋人工耳蜗植入患者进行大脑认知功能的评估,分析听觉获得后大脑加工信息变化的特点,探讨人工耳蜗植入后对患者大脑认知功能影响及植入年龄与大脑加工信息水平的相关性。结果:1.语前聋的大龄儿童及青少年术后言语听觉能力均有提升,婴幼儿组术后CAP分级评分5.79±1.07,SIR分级评分3.61±0.88,大龄儿童组术后CAP分级评分5.33±1.03,SIR分级评分3.22±0.65,青少年组术后CAP分级评分5.43±0.89,SIR分级评分3.00±0.63,SIR得分在各年龄分组间得分的差异有统计学意义(P=0.032),CAP得分在各年龄分组间得分的差异无统计学意义(P=0.212)。2.不同年龄组患者人工耳蜗植入后认知功能随植入时间延长呈上升趋势。其中大龄儿童组的同时性加工、注意能力开机后6个月末较术前明显提高(P=0.000),青少年组的注意能力开机后6个月较术前明显提高(P=0.000)。两组患者计划能力开机1年后与术前有显著差异(P0.001),青少年同时性加工能力开机1年后与术前有显著差异(P0.001)。3.大龄儿童与青少年术前E-CAS的计划、同时性加工、注意能力分量表得分无明显差异(P0.05),开机1年后,两组患者在计划(P=0.011)和继时性加工(P=0.000)能力方面得分有显著差异。同时性加工和注意能力差异无统计学意义(P0.05)。结论:1.不同年龄阶段语前聋患者术后均可以获得一定听觉言语能力,青少年语前聋患者长时间得不到听力补偿会造成言语发育的迟滞,可能有必要适当延长康复训练时间,以获得最佳言语康复效果。2.人工耳蜗植入后患者认知功能均有不同程度和进度提高,注意能力最快,其次同时性加工能力,计划能力进步最为缓慢。大龄儿童能力提高较青少年有一定优势。3.术后患者认知功能虽有提高,但总体认知水平仍处于同龄人低水平,认知功能较听觉言语功能需要更长时间的恢复。人工耳蜗植入患者远期认知功能是否与同龄人同水平,有待于进一步研究。
[Abstract]:Objective: to evaluate the rehabilitation effect of auditory speech and brain cognitive function after cochlear implantation in patients with severe or extremely severe sensorineural hearing loss. To analyze the effect of cochlear implantation on the cognitive function of the brain after hearing acquisition, and the characteristics of the changes of processing information in the brain of patients with different implantation ages. So as to provide reference for cochlear implantation and scientific rehabilitation training after operation in patients with prelingual deafness. Methods: 1, auditory behavior categories of auditory performance (CAP1) and speech intelligibility (speech intelligibility rating sir) were used to treat 62 cases of prelingual deafness with cochlear prosthesis. A questionnaire survey was conducted after implantation. The ability of auditory perception and speech rehabilitation was evaluated by using Electronic cognitive assessment system E-CAS, a digital remote cognitive evaluation system, to evaluate the cognitive function of 34 patients with prelingual deafness and cochlear implants aged from 5 to 17 years old. To analyze the characteristics of the changes of processing information in the brain after hearing acquisition, To investigate the effect of cochlear implantation on the cognitive function of the brain and the correlation between the age of implantation and the level of information about the processing of the brain. Results: 1. The speech and hearing ability of the older children and adolescents with prelingual deafness were improved after operation. The postoperative CAP score of infant group was 5.79 卤1.07U Sir score 3.61 卤0.88, the CAP score of older children group 5.33 卤1.03s Sir score 3.22 卤0.65, and the CAP score of adolescent group 5.43 卤0.89s Sir score 3.00 卤0.63s. There were significant differences among different age groups. There was no significant difference in the scores of P0. 032 and CAP among different age groups. The cognitive function of cochlear implants in different age groups showed an increasing trend with the extension of implantation time. At the end of 6 months after operation, the attention ability of the adolescent group was significantly improved than that of the preoperative group. There was a significant difference between the two groups in the planning ability of the two groups after one year of operation and before operation (P 0.001), and there was a significant difference between the two groups at the same time. There was significant difference in processing ability between before operation and after one year. The plan of E-CAS for older children and adolescents before operation was significant (P 0.001). There was no significant difference in the scores of simultaneous processing and attention ability subscale (P 0.05), but one year after boot, there was no significant difference in the score of the subscale. There were significant differences between the two groups in the scores of planning (P0. 011) and time following processing (P 0. 000). There was no significant difference in sexual processing and attention ability between the two groups (P 0. 05). Conclusion: 1. The patients with prelingual deafness at different ages can acquire certain hearing and speech ability after operation. Long time loss of hearing compensation in adolescents with prelingual deafness may result in speech development retardation. It may be necessary to extend the duration of rehabilitation training appropriately. In order to obtain the best speech rehabilitation effect. 2. The cognitive function of cochlear implant patients improved in varying degrees and progress, the ability of attention was the fastest, and the ability of simultaneous processing was the second. The improvement of planning ability is the slowest. 3. Although the cognitive function of the patients after operation has been improved, the overall cognitive level is still at the low level of the same age group. The long-term cognitive function of cochlear implant patients needs to be further studied.
【学位授予单位】：广西中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R764.9

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