【摘要】：目的：探討學(xué)齡前兒童單側(cè)人工耳蝸植入術(shù)后聽(tīng)覺(jué)言語(yǔ)康復(fù)效果和智力發(fā)育改善的相關(guān)因素,并分析比較我國(guó)標(biāo)準(zhǔn)化言語(yǔ)康復(fù)評(píng)估程序與國(guó)際通用評(píng)估方法評(píng)估結(jié)果的一致性。 方法：2006年1月至2013年4月,我科共對(duì)359例學(xué)齡前小于7歲兒童行單側(cè)人工耳蝸手術(shù)。其中臨床資料、耳聾基因檢測(cè)結(jié)果、術(shù)后1年的聽(tīng)覺(jué)言語(yǔ)康復(fù)和智力發(fā)育隨訪資料完整者165例,同時(shí)采用言語(yǔ)識(shí)別率、語(yǔ)言年齡、聽(tīng)覺(jué)行為分級(jí)(Categories of Auditory Performance,CAP)、言語(yǔ)可懂度分級(jí)(Speech Intelligibility Rating, SIR),按年齡、基因型、人工耳蝸植入體型號(hào)、有無(wú)助聽(tīng)器佩戴史以及有無(wú)EVAS分組研究其的聽(tīng)覺(jué)言語(yǔ)康復(fù)效果,并采用希-內(nèi)智力評(píng)估及智力發(fā)育情況。 結(jié)果：1.165例學(xué)齡前CI兒童中GJB2基因突變者48例(48/165,29.1%),SLC26A4突變者10例(10/165,6.06%),mt12sRNA突變者2例(2/165,1.2%)。2.165受試者言語(yǔ)識(shí)別率與CAP得分正性相關(guān)(r=0.405,p0.01),語(yǔ)言年齡與SIR得分正相關(guān)性(r=0.384,p0.01)。3.165例學(xué)齡前CI兒童聽(tīng)覺(jué)言語(yǔ)能力在術(shù)后12月內(nèi)均快速提高,言語(yǔ)識(shí)別率在康復(fù)12個(gè)月時(shí)平均值分別達(dá)到了85.3%,語(yǔ)言年齡達(dá)到：2.5歲,CAP達(dá)到：4.5,SIR達(dá)到：3.1。4.植入年齡為1～3歲CI兒童術(shù)后1年的聽(tīng)覺(jué)言語(yǔ)康復(fù)速度明顯快于4～6歲兒童；GJB2基因突變CI兒童的聽(tīng)覺(jué)言語(yǔ)康復(fù)及智力發(fā)育評(píng)估得分均高于非GIB2突變者；EVAS的CI兒童聽(tīng)覺(jué)言語(yǔ)康復(fù)及智力發(fā)育與非EVAS的CI兒童無(wú)差異；不同型號(hào)的人工耳蝸植入體對(duì)CI兒童的聽(tīng)覺(jué)言語(yǔ)康復(fù)影響不同,對(duì)智力發(fā)育影響無(wú)差異；助聽(tīng)器佩戴經(jīng)驗(yàn)對(duì)學(xué)齡前CI兒童術(shù)后1年的聽(tīng)覺(jué)能力有影響,對(duì)其言語(yǔ)能力及智力發(fā)育無(wú)影響。5.2～5歲兒童單側(cè)CI術(shù)后1年希-內(nèi)智力評(píng)分明顯高于同齡未手術(shù)聽(tīng)障兒童。 結(jié)論：1.CAP、SIR與言語(yǔ)識(shí)別率、語(yǔ)言年齡在評(píng)估聽(tīng)覺(jué)言語(yǔ)康復(fù)效果上具有較好的一致性,都可作為中國(guó)兒童CI術(shù)后康復(fù)效果的評(píng)估方法。2.GJB2基因突變的CI兒童的聽(tīng)覺(jué)語(yǔ)言康復(fù)及智力發(fā)育優(yōu)于非GJB2突變者；3. EVAS兒童CI術(shù)后康復(fù)效果與無(wú)前庭水管擴(kuò)大患兒無(wú)明顯差異。
[Abstract]:Aim: to investigate the related factors of auditory speech rehabilitation and mental development improvement in preschool children after unilateral cochlear implantation, and to analyze and compare the consistency between the evaluation procedure of standardized speech rehabilitation in China and the international evaluation methods. Methods: from January 2006 to April 2013, 359 preschool children under 7 years of age underwent unilateral cochlear surgery. Among them, clinical data, deafness gene test results, auditory speech rehabilitation and intellectual development follow-up data of 1 year after operation were complete in 165cases, and speech recognition rate, language age, auditory and behavioral grade (Categories of Auditory Performance,CAP were also used. Speech intelligibility grade (Speech Intelligibility Rating, SIR), was divided into four groups: age, genotype, cochlear implant type, hearing aid wearing history and EVAS group to study the effect of auditory speech rehabilitation. At the same time, the intelligence evaluation and the development of intelligence were adopted. Results: among the 1.165 preschool CI children, 48 (48 / 165, 29.1%) had GJB2 mutation and 10 (10 / 165, 6.06%) had SLC26A4 mutation. The speech recognition rate was positively correlated with the CAP score (r = 0.405, p0.01), and the language age was positively correlated with the SIR score (r = 0.384, P < 0.01) in 2.165 subjects with mt12sRNA mutation (2 / 165, 1.2%). (P0. 01). The auditory speech ability of 3.165 preschool CI children increased rapidly within 12 months after operation, the average speech recognition rate reached 85. 3% after 12 months of rehabilitation, and the language age was 2. 5 years old. CAP: 4.5, Sir: 3.1.4. The rate of auditory speech rehabilitation in CI children aged 1 to 3 years after operation was significantly faster than that in children aged 4 to 6 years, and the scores of auditory speech rehabilitation and intelligence development in CI children with GJB2 gene mutation were higher than those in non-GIB2 mutation children. There was no difference in auditory speech rehabilitation and intellectual development between CI children with EVAS and non-EVAS children with CI, and the effects of cochlear implants on auditory speech rehabilitation and intelligence development in CI children were not different from those in non-EVAS children, and there was no difference in the effects of cochlear implants on hearing and speech rehabilitation in CI children. Hearing aid wearing experience has an impact on the hearing ability of preschool CI children 1 year after operation. There was no effect on speech ability and intelligence development in 5-year-old children with unilateral CI. The score was significantly higher in 5-year-old children than that in unoperated children with hearing impairment at one year after operation. CAP, Sir and speech recognition rate, language age have good consistency in evaluating the effect of auditory speech rehabilitation. 2. 2. The hearing and speech rehabilitation and intelligence development of CI children with GJB2 gene mutation were better than those without GJB2 mutation; 2. CI children with GJB2 gene mutation had better hearing and speech rehabilitation and intelligence development than those without GJB2 mutation. 3. There was no significant difference between EVAS children and children without vestibular aqueduct enlargement after CI.
【學(xué)位授予單位】：中南大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類(lèi)號(hào)】：R764.9

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 陳塏鈿;宗凌;周蔚;劉敏;姜鴻彥;;200例非綜合征型聾患者GJB3和GJB6基因突變分析[J];聽(tīng)力學(xué)及言語(yǔ)疾病雜志;2012年03期

2 張志利;曹克利;魏朝剛;欒蘭;李歡;;Waardenburg綜合征患者人工耳蝸植入后效果分析[J];聽(tīng)力學(xué)及言語(yǔ)疾病雜志;2009年04期

3 肖自安,謝鼎華;內(nèi)耳間隙連接和連接蛋白基因家族與遺傳性聾[J];中國(guó)耳鼻咽喉顱底外科雜志;2005年03期

4 韓德民;中國(guó)多道人工耳蝸植入現(xiàn)狀[J];中華耳鼻咽喉科雜志;2004年02期

5 韓東一,武文明,郗昕,黃德亮,楊偉炎;先天性內(nèi)耳畸形的人工耳蝸植入[J];中華耳鼻咽喉科雜志;2004年02期

6 冀飛,郗昕,洪夢(mèng)迪,韓東一,黃德亮,武文明;語(yǔ)前聾人工耳蝸植入患者聽(tīng)覺(jué)和言語(yǔ)康復(fù)效果的問(wèn)卷分級(jí)評(píng)估[J];中華耳鼻咽喉科雜志;2004年10期

7 劉軍;戴樸;韓東一;;人工耳蝸植入的效果評(píng)估[J];中華耳科學(xué)雜志;2007年01期

8 顏玉君;李蘊(yùn);楊濤;黃琦;吳皓;;GJB2及SLC26A4基因突變患兒耳蝸植入效果分析[J];中華耳科學(xué)雜志;2011年02期

9 洪夢(mèng)迪;楊仕明;陳艾婷;郗昕;;人工耳蝸術(shù)后患兒聽(tīng)閾評(píng)估[J];中華耳科學(xué)雜志;2012年01期

10 曹永茂,龍墨,夏彬,雷培香,銀力;術(shù)前配戴助聽(tīng)器對(duì)人工耳蝸植入后康復(fù)的作用[J];中華物理醫(yī)學(xué)與康復(fù)雜志;2003年04期

，

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