本文選題：皮層聽覺誘發(fā)電位　切入點(diǎn)：人工耳蝸　出處：《鄭州大學(xué)》2012年碩士論文

【摘要】：目的 本研究觀察人工耳蝸患兒手術(shù)后皮層聽覺誘發(fā)電位(cortical auditory evoked potential, CAEP)中P1-N1-P2的發(fā)育規(guī)律,分析人工耳蝸手術(shù)后患兒的P1波的發(fā)展規(guī)律及與人工耳蝸佩戴時(shí)間和言語測聽量表得分的相關(guān)性。通過比較正常兒童聽覺皮層誘發(fā)電位的發(fā)育規(guī)律,分析人工耳蝸手術(shù)后患兒聽覺皮層誘發(fā)電位的發(fā)展規(guī)律,總結(jié)出人工耳蝸手術(shù)的最佳年齡,并分析手術(shù)植入年齡對(duì)聽覺皮層發(fā)育的影響,為兒童使用助聽裝置后成效的評(píng)估和康復(fù)方案的制定提供幫助。 方法 1.研究對(duì)象 1.1正常兒童的選�。弘S機(jī)選取北京市西城區(qū)人工耳蝸康復(fù)中心正常兒童10名,男性6名,女性4名,最小年齡24月,最大年齡74月,平均年齡50月； 1.2人工耳蝸患兒的選�。弘S機(jī)選取自2005年至2011年在北京市通州區(qū)人工耳蝸康復(fù)中心人工耳蝸植入術(shù)后兒童39名,其中男性24名和女性15名,最小年齡25月,最大年齡248月,平均年齡46月。研究中7名患兒因基本資料不全而退出此研究,剩余32名,男性20名,女性12名,最小年齡25月,最大年齡121月,平均年齡59月；均為語前聾,術(shù)前未使用過助聽器,最小手術(shù)年齡5月,最大手術(shù)年齡72月,平均康復(fù)訓(xùn)練時(shí)間lh/d。 2.實(shí)驗(yàn)儀器及測試壞境 CAEP i(?)錄電位采用澳大利亞Hearlab測試系統(tǒng),測試地點(diǎn)為背景噪聲小于30dB(A)的安靜教室內(nèi),受試者要保持警醒、安靜狀態(tài)。 3.測試材料 采用問卷形式的印第安納醫(yī)學(xué)院及諾丁漢兒童人工耳蝸中心編制的家長問卷形式的嬰幼兒有意義聽覺整合量級(jí)測試(the infant-toddler meaningful auditory integration scale, IT-MAIS)、聽覺整合量表(meaningful auditory integration scale,MAIS)和聽覺行為分級(jí)標(biāo)準(zhǔn)(the categories of auditory performance, CAP),有意義言語使用量表(meaningful use of speech scale, MUSS)以及言語可懂度分級(jí)標(biāo)準(zhǔn)(speech intelligibility rating, SIR)。測試材料具體見附錄。 4、實(shí)驗(yàn)操作步驟 4.1記錄方法：記錄電極置于顱頂,參考電極置于非術(shù)耳乳突側(cè),地極置于鼻根部,電極阻抗要低于3kQ。受試者佩戴好電極后,通過觀看無聲動(dòng)畫片來保持警醒、安靜狀態(tài)。打開測試系統(tǒng),選定聲場助聽下測試,記錄波形開窗時(shí)間為700ms,包括刺激聲前100ms和刺激聲后600ms,重復(fù)周期為1125ms,疊加次數(shù)2次/s,偽跡拒絕范圍-150mv到+150mv。刺激聲強(qiáng)度為校準(zhǔn)后的65dB SPL,記錄P1、N1、P2波,每個(gè)波形重復(fù)記錄兩次。 4.2問卷記錄方法：由經(jīng)過培訓(xùn)的專業(yè)聽力師以問卷調(diào)查的形式,向患兒父母或監(jiān)護(hù)人詢問四種言語測聽量表,評(píng)估前可由專業(yè)人員對(duì)家長進(jìn)行必要的指導(dǎo),由專業(yè)人員對(duì)問題逐一提問,患兒在日常生活中對(duì)聽力方面的自發(fā)性反應(yīng)家長要盡可能詳細(xì)的描述,專業(yè)人員根據(jù)父母的詳細(xì)回答來進(jìn)行評(píng)分。 4、統(tǒng)計(jì)學(xué)分析 本實(shí)驗(yàn)數(shù)據(jù)采用SPSS17.0統(tǒng)計(jì)學(xué)軟件分析。 1.分析不同刺激聲下的P1波的引出率 應(yīng)用卡方檢驗(yàn)(?)口Bonferroni統(tǒng)計(jì)方法對(duì)人工耳蝸手術(shù)后兒童不同刺激聲下P1、N1、P2的引出率進(jìn)行比較,P0.05認(rèn)為有統(tǒng)計(jì)學(xué)意義。 2.分析不同刺激聲下佩戴時(shí)間和P1潛伏期、幅度的相關(guān)性 應(yīng)用兩變量關(guān)聯(lián)性分析,對(duì)患兒佩戴時(shí)間和P1潛伏期、幅度進(jìn)行相關(guān)性分析,P0.05認(rèn)為有統(tǒng)計(jì)學(xué)意義。 3.分析不同刺激聲下P1潛伏期、幅度與量表得分的相關(guān)性 應(yīng)用兩變量關(guān)聯(lián)性分析,對(duì)患兒P1潛伏期、幅度和各個(gè)量表得分的相關(guān)性分析,P0.05認(rèn)為有統(tǒng)計(jì)學(xué)意義。 4.分析年齡對(duì)P1潛伏期的影響 應(yīng)用秩和檢驗(yàn)對(duì)正常兒童、植入年齡≤42月人工耳蝸植入術(shù)后兒童,植入年齡42月人工耳蝸植入術(shù)后兒童的P1潛伏期進(jìn)行統(tǒng)計(jì)學(xué)分析,P0.05認(rèn)為有統(tǒng)計(jì)學(xué)意義。 結(jié)果 1.32名人工耳蝸佩戴兒童不同刺激聲下P1、N1、P2各波引出率的比較 當(dāng)刺激聲為/M/、/T/、/G/時(shí),用卡方檢驗(yàn)和Bonferron i統(tǒng)計(jì)方法對(duì)人工耳蝸手術(shù)后兒童P1、N1、P2的引出率進(jìn)行比較。三種刺激聲下P1、N1、P2出現(xiàn)次數(shù)分布圖各個(gè)刺激聲下的P1、N1、P2不同的刺激聲下P1與N1兩組間引出率的P值0.05,兩組間有統(tǒng)計(jì)學(xué)意義；P1與P2兩組間的引出率的P值0.05,兩組間有統(tǒng)計(jì)學(xué)意義；N1與P2兩組間P＞0.05,兩組間無統(tǒng)計(jì)學(xué)差異。不同刺激聲下,與N1、P2相比較,P1波被引出的次數(shù)要大于N1、P2波的次數(shù),因此在人工耳蝸手術(shù)后的兒童中P1波較穩(wěn)定出現(xiàn)。 2.M/T/G刺激聲下P1波潛伏期和幅度與佩戴時(shí)間的相關(guān)性分析 當(dāng)刺激聲為/M/、/T/、/G/時(shí),對(duì)患兒佩戴時(shí)間和P1潛伏期、幅度進(jìn)行關(guān)聯(lián)性分析,當(dāng)刺激聲為/M/時(shí),相關(guān)系數(shù)為-0.363,P0.05,二者有統(tǒng)計(jì)學(xué)差異,說明佩戴時(shí)間與P1潛伏期呈負(fù)相關(guān),與P1幅度也呈負(fù)相關(guān)；而當(dāng)刺激聲/T/、/G/時(shí),患兒佩戴時(shí)間和P1潛伏期P＞0.05,說明佩戴時(shí)間與P1潛伏期無相關(guān)性。 3.M/T/G刺激聲下P1潛伏期和幅度與量表得分的相關(guān)性分析 當(dāng)刺激聲為/M/、/T/、/G/時(shí),P1波幅度與各個(gè)量表得分均呈正相關(guān),P值均0.05,有統(tǒng)計(jì)學(xué)意義；而P1潛伏期與MUSS、 CAP呈負(fù)相關(guān),P值均0.05,有統(tǒng)計(jì)學(xué)意義,與(IT)MAIS、SIR無相關(guān)性,P值均0.05。 4.年齡與P1潛伏期的統(tǒng)計(jì)分析 4.1.當(dāng)刺激聲為/M/時(shí),正常兒童與人工耳蝸植入術(shù)≤42月患兒P1潛伏期112.20±14.57,122.29±13.60,P=0.079；當(dāng)刺激聲為/T/時(shí)、正常兒童與人工耳蝸植入術(shù)≤42月患兒P1潛伏期113.30±14.61,119.70±15.44,P=0.421；當(dāng)刺激聲為/G/時(shí)、正常兒童與人工耳蝸植入術(shù)≤42月患兒P1潛伏期110.40±12.45,118.71±12.94,P=0.097。 4.2.當(dāng)刺激聲為/M/時(shí),正常兒童與人工耳蝸植入術(shù)＞42月患兒P1潛伏期112.20±14.57,133.00±14.55,P=0.006；當(dāng)刺激聲為/T/時(shí)、正常兒童與人工耳蝸植入術(shù)42月患兒P1潛伏期113.30±14.61,135.20±13.76,P=0.002；當(dāng)刺激聲為/G/時(shí)、正常兒童與人工耳蝸植入術(shù)42月患兒P1潛伏期110.40±12.45,136.07±14.33,P=0.000。 4.3.當(dāng)刺激聲為/M/時(shí),人工耳蝸植入術(shù)≤42月患兒與42月患兒P1潛伏期122.29±13.60,133.00±14.55,P=0.006；當(dāng)刺激聲為/T/時(shí),人工耳蝸植入術(shù)≤42月患兒與42月患兒P1潛伏期119.70±15.44,135.20±13.76,P=0.002；當(dāng)刺激聲為/G/時(shí),人工耳蝸植入術(shù)≤42月患兒與42月患兒P1潛伏期118.71±12.94,136.07±14.33,P=0.000。 結(jié)論 1.人工耳蝸手術(shù)患兒的CAEP主要能觀察到3個(gè)波,P1、N1、P2波。其中P1出現(xiàn)率為100%。P1的潛伏期和波幅是CI術(shù)后的患兒CAEP內(nèi)主要觀察指標(biāo)。P1幅度與量表得分的相關(guān)性較P1潛伏期與量表得分的相關(guān)性好。 2.低頻下P1潛伏期和幅度易受患兒佩戴時(shí)間的影響。 3.通過觀察P1波潛伏期,42月前是兒童人工耳蝸植入的最佳時(shí)期。人工耳蝸植入年齡≤42月的患兒,P1潛伏期與正常兒童接近。。 4.患兒言語測聽結(jié)果與CAEP相關(guān)性好,言語測聽得分高者提示CAEP發(fā)育好,因此CAEP的P1測定技術(shù)對(duì)人工耳蝸術(shù)后患兒言語識(shí)別能力、言語康復(fù)效果的評(píng)估有重要的應(yīng)用價(jià)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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