241例人工耳蜗植入儿童1年期康复效果个体内在影响因素的相关性研究

The Correlation between the Internal Factors and the Rehabilitation Outcomes of 241 Children One Year after Cochlear Implantation

目的分析影响人工耳蜗植入儿童术后1年听觉、语言能力发展的内在因素，为实施康复效果质量监控及改善安置策略提供指导。方法选取24l例资料完整已接受为期1年系统康复训练的人工耳蜗植入儿童为调查对象，以其术后不同的安置时段（3个月、6个月、9个月和12个月）的评估数据（包括听觉能力、语言能力、学爿能力）为参考，采用相关性分析的方法，研究不同安置时段个体内在因素与听力语言康复效果之间的相关性。结果①术前双耳听觉能力、语言能力评估成绩与术后3个月的同类能力评估成绩间存在低度以上的线性相关（r≥0．3，P〈0．01），但与3个月后同类能力评估成绩相关性不显著（r〈0．3，P〉0．01）；②术后康复1年内，听觉、语言能力不同安置阶段的评估成绩间存在低度以上的线性相关（r≥0．3，P〈0．01），听觉能力或语言能力每相邻的两个安置阶段的评估成绩间存在中度（0．5≤r〈0．8，P〈0．01）甚至高度（r≥0．8，P〈0．01）的线性相关③在同一安置时段，听觉能力和语言能力评估成绩间线性相关性最大，达到中度以上相关（0．5≤r〈0．8，P〈0．01）。结论①人工耳蜗植入儿童术后1年的康复效果受到来自个体内在因素的影响；②外在因素的影响度小于个体内在因素的影响度；③术后康复单一能力领域的发展影响，前一安置时段与后一安置时段康复效果的关联度最大；④术后康复跨能力领域的发展影响，相同安置时段内听觉能力与语言能力发展的关联度最大。

Objective To analyze the internal factors that affect auditory and language development of children with cochlear implants during one year postoperative training so as to provide guidance for outcome supervision and strategy improvement. Methods 241 implanted children who received one-year systematic rehabilitation were selected as the subjects. The correlations between individual factors and auditory language rehabilitation outcomes were studied based on the assessment results （auditory skills, language skills and learning ability scores） at different postoperative intervals （3, 6, 9, 12 months）. Results （1） The correlations between preoperative binaural hearing or language skills and corresponding skills at 3 months after cochlear implantation were significant （Irl_〉 0.3, P〈0.01）, but not significant after that time （Irl 〈0.3, P〉0.01）. （2）Within one year of rehabilitation, there were significant correlations between different postoperative intervals in auditory or language skills （Irl〉 0.3, P〈O.01）, and moderate （0.5〈1r1〈0.8, P〈0.O1） or even high （Irl~ 0.8, P〈O.01） correlations between adjacent postoperative intervals. （3）The correlations between hearing and language scores were the most significant within the same postoperative intervals （0.5 〈lrl 〈0.8, P〈0.01）. Conclusion （1） The rehabilitation outcomes one year after implantation are affected by internal factors. （2） The effects of external factors are less important than those of internal factors. （3）The correlations of rehabilitation outcomes in the aspect of single area skills are the most significant between adjacent postoperative intervals. （4） The correlations of rehabilitation outcomes in the aspect of cross area skills are the most significant within the same postoperative intervals.