皮层听觉诱发电位P1-N1-P2在儿童人工耳蜗植入效果评估中的应用

发布时间：2018-03-31 21:50

  本文选题：皮层听觉诱发电位　切入点：人工耳蜗　出处：《郑州大学》2012年硕士论文

【摘要】：目的 本研究观察人工耳蜗患儿手术后皮层听觉诱发电位(cortical auditory evoked potential, CAEP)中P1-N1-P2的发育规律,分析人工耳蜗手术后患儿的P1波的发展规律及与人工耳蜗佩戴时间和言语测听量表得分的相关性。通过比较正常儿童听觉皮层诱发电位的发育规律,分析人工耳蜗手术后患儿听觉皮层诱发电位的发展规律,总结出人工耳蜗手术的最佳年龄,并分析手术植入年龄对听觉皮层发育的影响,为儿童使用助听装置后成效的评估和康复方案的制定提供帮助。 方法 1.研究对象 1.1正常儿童的选取：随机选取北京市西城区人工耳蜗康复中心正常儿童10名,男性6名,女性4名,最小年龄24月,最大年龄74月,平均年龄50月； 1.2人工耳蜗患儿的选取：随机选取自2005年至2011年在北京市通州区人工耳蜗康复中心人工耳蜗植入术后儿童39名,其中男性24名和女性15名,最小年龄25月,最大年龄248月,平均年龄46月。研究中7名患儿因基本资料不全而退出此研究,剩余32名,男性20名,女性12名,最小年龄25月,最大年龄121月,平均年龄59月；均为语前聋,术前未使用过助听器,最小手术年龄5月,最大手术年龄72月,平均康复训练时间lh/d。 2.实验仪器及测试坏境 CAEP i(?)录电位采用澳大利亚Hearlab测试系统,测试地点为背景噪声小于30dB(A)的安静教室内,受试者要保持警醒、安静状态。 3.测试材料 采用问卷形式的印第安纳医学院及诺丁汉儿童人工耳蜗中心编制的家长问卷形式的婴幼儿有意义听觉整合量级测试(the infant-toddler meaningful auditory integration scale, IT-MAIS)、听觉整合量表(meaningful auditory integration scale,MAIS)和听觉行为分级标准(the categories of auditory performance, CAP),有意义言语使用量表(meaningful use of speech scale, MUSS)以及言语可懂度分级标准(speech intelligibility rating, SIR)。测试材料具体见附录。 4、实验操作步骤 4.1记录方法：记录电极置于颅顶,参考电极置于非术耳乳突侧,地极置于鼻根部,电极阻抗要低于3kQ。受试者佩戴好电极后,通过观看无声动画片来保持警醒、安静状态。打开测试系统,选定声场助听下测试,记录波形开窗时间为700ms,包括刺激声前100ms和刺激声后600ms,重复周期为1125ms,叠加次数2次/s,伪迹拒绝范围-150mv到+150mv。刺激声强度为校准后的65dB SPL,记录P1、N1、P2波,每个波形重复记录两次。 4.2问卷记录方法：由经过培训的专业听力师以问卷调查的形式,向患儿父母或监护人询问四种言语测听量表,评估前可由专业人员对家长进行必要的指导,由专业人员对问题逐一提问,患儿在日常生活中对听力方面的自发性反应家长要尽可能详细的描述,专业人员根据父母的详细回答来进行评分。 4、统计学分析 本实验数据采用SPSS17.0统计学软件分析。 1.分析不同刺激声下的P1波的引出率 应用卡方检验(?)口Bonferroni统计方法对人工耳蜗手术后儿童不同刺激声下P1、N1、P2的引出率进行比较,P0.05认为有统计学意义。 2.分析不同刺激声下佩戴时间和P1潜伏期、幅度的相关性 应用两变量关联性分析,对患儿佩戴时间和P1潜伏期、幅度进行相关性分析,P0.05认为有统计学意义。 3.分析不同刺激声下P1潜伏期、幅度与量表得分的相关性 应用两变量关联性分析,对患儿P1潜伏期、幅度和各个量表得分的相关性分析,P0.05认为有统计学意义。 4.分析年龄对P1潜伏期的影响 应用秩和检验对正常儿童、植入年龄≤42月人工耳蜗植入术后儿童,植入年龄42月人工耳蜗植入术后儿童的P1潜伏期进行统计学分析,P0.05认为有统计学意义。 结果 1.32名人工耳蜗佩戴儿童不同刺激声下P1、N1、P2各波引出率的比较 当刺激声为/M/、/T/、/G/时,用卡方检验和Bonferron i统计方法对人工耳蜗手术后儿童P1、N1、P2的引出率进行比较。三种刺激声下P1、N1、P2出现次数分布图各个刺激声下的P1、N1、P2不同的刺激声下P1与N1两组间引出率的P值0.05,两组间有统计学意义；P1与P2两组间的引出率的P值0.05,两组间有统计学意义；N1与P2两组间P＞0.05,两组间无统计学差异。不同刺激声下,与N1、P2相比较,P1波被引出的次数要大于N1、P2波的次数,因此在人工耳蜗手术后的儿童中P1波较稳定出现。 2.M/T/G刺激声下P1波潜伏期和幅度与佩戴时间的相关性分析 当刺激声为/M/、/T/、/G/时,对患儿佩戴时间和P1潜伏期、幅度进行关联性分析,当刺激声为/M/时,相关系数为-0.363,P0.05,二者有统计学差异,说明佩戴时间与P1潜伏期呈负相关,与P1幅度也呈负相关；而当刺激声/T/、/G/时,患儿佩戴时间和P1潜伏期P＞0.05,说明佩戴时间与P1潜伏期无相关性。 3.M/T/G刺激声下P1潜伏期和幅度与量表得分的相关性分析 当刺激声为/M/、/T/、/G/时,P1波幅度与各个量表得分均呈正相关,P值均0.05,有统计学意义；而P1潜伏期与MUSS、 CAP呈负相关,P值均0.05,有统计学意义,与(IT)MAIS、SIR无相关性,P值均0.05。 4.年龄与P1潜伏期的统计分析 4.1.当刺激声为/M/时,正常儿童与人工耳蜗植入术≤42月患儿P1潜伏期112.20±14.57,122.29±13.60,P=0.079；当刺激声为/T/时、正常儿童与人工耳蜗植入术≤42月患儿P1潜伏期113.30±14.61,119.70±15.44,P=0.421；当刺激声为/G/时、正常儿童与人工耳蜗植入术≤42月患儿P1潜伏期110.40±12.45,118.71±12.94,P=0.097。 4.2.当刺激声为/M/时,正常儿童与人工耳蜗植入术＞42月患儿P1潜伏期112.20±14.57,133.00±14.55,P=0.006；当刺激声为/T/时、正常儿童与人工耳蜗植入术42月患儿P1潜伏期113.30±14.61,135.20±13.76,P=0.002；当刺激声为/G/时、正常儿童与人工耳蜗植入术42月患儿P1潜伏期110.40±12.45,136.07±14.33,P=0.000。 4.3.当刺激声为/M/时,人工耳蜗植入术≤42月患儿与42月患儿P1潜伏期122.29±13.60,133.00±14.55,P=0.006；当刺激声为/T/时,人工耳蜗植入术≤42月患儿与42月患儿P1潜伏期119.70±15.44,135.20±13.76,P=0.002；当刺激声为/G/时,人工耳蜗植入术≤42月患儿与42月患儿P1潜伏期118.71±12.94,136.07±14.33,P=0.000。 结论 1.人工耳蜗手术患儿的CAEP主要能观察到3个波,P1、N1、P2波。其中P1出现率为100%。P1的潜伏期和波幅是CI术后的患儿CAEP内主要观察指标。P1幅度与量表得分的相关性较P1潜伏期与量表得分的相关性好。 2.低频下P1潜伏期和幅度易受患儿佩戴时间的影响。 3.通过观察P1波潜伏期,42月前是儿童人工耳蜗植入的最佳时期。人工耳蜗植入年龄≤42月的患儿,P1潜伏期与正常儿童接近。。 4.患儿言语测听结果与CAEP相关性好,言语测听得分高者提示CAEP发育好,因此CAEP的P1测定技术对人工耳蜗术后患儿言语识别能力、言语康复效果的评估有重要的应用价值。
[Abstract]:Purpose

In this study , the developmental regularity of P1 - N1 - P2 in children with cochlear implantation was investigated . The development of P1 - wave in children with cochlear operation was analyzed . The development of auditory cortex evoked potential was analyzed by comparing the developmental regularity of auditory cortex evoked potential in children with cochlear operation , the optimal age of cochlear operation was analyzed , and the influence of implantation age on auditory cortex development was analyzed .

method

1 . Study Object

1.1 Normal children were selected randomly : 10 normal children , 6 males and 4 females , with a minimum age of 24 months , a maximum age of 74 months and an average age of 50 months .


1.2 Selection of children with cochlear implantation : 39 children were randomly selected from 2005 to 2011 , including 24 males and 15 females , with a minimum age of 25 months , a maximum age of 24months , and an average age of 46 months . Seven of the children who were enrolled in the study were withdrawn from the study due to incomplete basic data . The remaining 32 males , 20 females , 12 females , the minimum age were 25 months , the maximum age was 121 months , the mean age was 59 months ;
The hearing aid was not used before operation , the minimum operative age was 5 months , the maximum operative age was 72 months , and the average rehabilitation training time was 1h / d .

2 . Experimental instruments and test bad conditions

The CAEP i ( ? ) recording potential is in a quiet classroom with a background noise of less than 30 dB ( A ) in a quiet classroom with a background noise of less than 30 dB ( A ) using the Hearlab test system in Australia .

3 . Test Materials

There were meaningful auditory integration scale ( IT - MAIS ) , auditory integration scale ( MAIS ) and auditory behavior classification standard ( the categories of auditory performance , CAP ) , meaningful use of speech scale ( MUSS ) and speech intelligibility rating ( SIR ) . The test materials are specified in the appendix .

4 . Operation steps of the experiment

4.1 Recording method : The recording electrode is placed on the skull top , the reference electrode is placed on the non - operation ear mastoid side , the ground electrode is placed on the root of the nose , the electrode impedance is lower than 3 kQ . After wearing the electrode , the test system is opened , and the recording waveform windowing time is 700ms , including 100 ms and 600ms after stimulation , the repetition period is 1125ms , the superposition time is 2 times / s , the artifact rejection range is -150mv to + 150mv . The stimulation acoustic intensity is 65dB SPL after calibration , and each waveform is repeatedly recorded twice .

4.2 Questionnaire recording method : Ask the parents or guardians of the children to ask the four kinds of speech measurement scales in the form of a questionnaire by trained professional audiologist . Before the assessment , the professionals should guide the parents , ask the questions one by one by the professionals , and the children will make a detailed description of the spontaneous reaction parents in daily life , and the professionals will score according to the detailed answers of the parents .

4 . Statistical Analysis

SPSS 17.0 was used to analyze the experimental data .

1 . Analysis of the extraction rate of P1 wave under different stimulus sounds

The extraction rates of P1 , N1 , and P2 in children after cochlear operation were compared by using the chi - square test ( ? ) method , P < 0.01 , P < 0.01 , P < 0.01 , P < 0.01 , P < 0.01 , P < 0.01 , P < 0.01 , P < 0.01 , P < 0.01 , P < 0.01 , P < 0.01 , P < 0.01 , P < 0.01 , P < 0.01 , P < 0.01 , P < 0.01 , P < 0.01 , P < 0.01 , P < 0.01 , P < 0.01 , P < 0.01 , P < 0.01 , P < 0.01 , P < 0.01 , P < 0.01 , P < 0.01

2 . Analysis of the correlation between the wearing time and P1 latency and amplitude in different stimulus sounds

The relationship between the wearing time and the latency and amplitude of the infant were analyzed by the two variables correlation analysis , and the statistical significance was found in P0.05 .

3 . Analysis of the correlation between P1 latency , amplitude and scale scores in different stimulus sounds

The correlation between P1 latency , amplitude and the scores of each scale was analyzed by two variables correlation analysis , P < 0.01 , P < 0.05 , P < 0.05 , P < 0.05 , P < 0.05 , P < 0.05 , P < 0.05 , P < 0.05 , P < 0.05 , P < 0.05 , P < 0.05 , P < 0.05 , P < 0.05 , P < 0.05 , P < 0.05 , P < 0.05 , P < 0.05 , P

4 . Analysis of the effect of age on P1 latency

The P1 latency of children with normal children , implantation age 鈮，

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