语前聋患者人工耳蜗植入术后听觉言语康复相关影响因素的研究

Research on the Influencing Factors of Auditory and Speech Rehabilitation Outcomes of Prelingually Deaf Patients with Cochlear Implants

目的探讨语前聋人工耳蜗植入患者的听觉言语康复效果及其相关影响因素。方法对159例人工耳蜗植入患者家长和康复教师进行调查随访。根据听觉行为分级标准（CategoriesofAuditoryPerformance，CAP）和言语可懂度分级标准（SpeechIntelligibilityRating，SIR），对患者的听觉能力和言语能力进行分级评估。用组内单因素秩和检验和多因素Logistic回归分析CAP和SIR分级结果与性别、惯用手、内耳发育、颅脑影像学情况、术前助听器使用、术前语训、植入耳侧、植入电极类型、植入年龄、植入后时间、术后语言环境、术后康复模式、家庭经济状况等13个因素的关系。结果单因素分析结果显示，不同的术前助听器使用情况、术前语训、植入后时间、家庭经济状况组间CAP分级结果有显著性差异（P值均〈0．05）；不同的植入耳侧、植入后时间、家庭经济状况组间SIR分级结果有显著性差异（P值均〈0．05）。多因素Logistic回归分析结果显示，植入后时间、家庭经济状况与CAP、SIR分级结果均有显著相关。结论植入后时间、家庭经济状况对人工耳蜗植入术后患者的听觉言语康复效果起决定性的作用。

Objective To explore the auditory and speech rehabilitation outcomes of prelingually hearing- impaired patients with cochlear implants and the related influencing factors. Methods One hundred fifty-nine cochlear implantees were recruited in this study.The parents or teachers were interviewed to assess the auditory and speech abilities of the subjects using Categories of Auditory Performance （CAP） and Speech Intelligibility Rating （SIR）. The relationships were investigated between auditory and speech rehabilitation outcomes represented by CAP/SIR results and 13 possible influencing factors including gender, handedness, inner ear malformations, brain abnormalities, hearing aid use, language training before surgery, implanted ear, type of implant, age at implantation, rehabilitation time after surgery, language atmosphere after surgery, rehabilitation mode and family financial conditions. Univariate test and multivariate stepwise Logistic regression were used for statistical analysis. Results The univariate analysis indicated that there were significant differences in CAP scores between different groups in terms of hearing aid use, language training before surgery, rehabilitation time after surgery and family financial conditions（P〈0.05）.There were significant differences in SIR scores between different groups in terms of implanted ear, rehabilitation time after surgery and family financial conditions（P〈0.05）.The multivariate analysis using stepwise Logistic regression model showed that the rehabilitation time after surgery and family financial conditions were significantly correlated with CAP and SIR scores. Conclusion The rehabilitation time after surgery and family financial conditions play a decisive role in the auditory and speech rehabilitation outcomes of patients with cochlear implants.