本文選題：人工耳蝸植入　切入點：語前聾　出處：《廣西中醫(yī)藥大學》2017年碩士論文　論文類型：學位論文

【摘要】：目的:通過對重度或極重度感音神經性聾中語前聾患者人工耳蝸植入后聽覺言語及大腦認知功能康復效果進行評估,分析聽覺獲得后人工耳蝸對患者大腦認知功能的影響及不同植入年齡患者大腦加工信息的變化的特點,從而為語前聾患者人工耳蝸植入和術后科學性的康復訓練提供參考依據。方法:1、采用聽覺行為分級(categories of auditory performance,CAP)和言語可懂度分級(speech intelligibility rating,SIR)對62例語前聾患者人工耳蝸植入術后進行問卷調查隨訪,對其聽覺感知和言語康復能力進行評估。2、應用數字化遠程認知評估系統(tǒng)(Electronic cognitive assessment system,E-CAS)對34例5歲-17歲的語前聾人工耳蝸植入患者進行大腦認知功能的評估,分析聽覺獲得后大腦加工信息變化的特點,探討人工耳蝸植入后對患者大腦認知功能影響及植入年齡與大腦加工信息水平的相關性。結果:1.語前聾的大齡兒童及青少年術后言語聽覺能力均有提升,嬰幼兒組術后CAP分級評分5.79±1.07,SIR分級評分3.61±0.88,大齡兒童組術后CAP分級評分5.33±1.03,SIR分級評分3.22±0.65,青少年組術后CAP分級評分5.43±0.89,SIR分級評分3.00±0.63,SIR得分在各年齡分組間得分的差異有統(tǒng)計學意義(P=0.032),CAP得分在各年齡分組間得分的差異無統(tǒng)計學意義(P=0.212)。2.不同年齡組患者人工耳蝸植入后認知功能隨植入時間延長呈上升趨勢。其中大齡兒童組的同時性加工、注意能力開機后6個月末較術前明顯提高(P=0.000),青少年組的注意能力開機后6個月較術前明顯提高(P=0.000)。兩組患者計劃能力開機1年后與術前有顯著差異(P0.001),青少年同時性加工能力開機1年后與術前有顯著差異(P0.001)。3.大齡兒童與青少年術前E-CAS的計劃、同時性加工、注意能力分量表得分無明顯差異(P0.05),開機1年后,兩組患者在計劃(P=0.011)和繼時性加工(P=0.000)能力方面得分有顯著差異。同時性加工和注意能力差異無統(tǒng)計學意義(P0.05)。結論:1.不同年齡階段語前聾患者術后均可以獲得一定聽覺言語能力,青少年語前聾患者長時間得不到聽力補償會造成言語發(fā)育的遲滯,可能有必要適當延長康復訓練時間,以獲得最佳言語康復效果。2.人工耳蝸植入后患者認知功能均有不同程度和進度提高,注意能力最快,其次同時性加工能力,計劃能力進步最為緩慢。大齡兒童能力提高較青少年有一定優(yōu)勢。3.術后患者認知功能雖有提高,但總體認知水平仍處于同齡人低水平,認知功能較聽覺言語功能需要更長時間的恢復。人工耳蝸植入患者遠期認知功能是否與同齡人同水平,有待于進一步研究。
[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 鹵1.07U Sir score 3.61 鹵0.88, the CAP score of older children group 5.33 鹵1.03s Sir score 3.22 鹵0.65, and the CAP score of adolescent group 5.43 鹵0.89s Sir score 3.00 鹵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.
【學位授予單位】：廣西中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R764.9

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