东西部地区影响早期人工耳蜗植入相关因素的研究

Study on the factors impacting on early cochlear implantation between the eastern and western region of China

目的:研究影响语前聋患儿早期人工耳蜗植入相关因素的区域差异。方法:回顾分析来自东部地区(江苏、浙江、上海)的45例和西部地区(宁夏、贵州)的68例耳蜗植入年龄大于24月龄患儿的病历资料,通过调查问卷了解影响早期耳蜗植入因素的分布情况,进行单因素和多因素Logistic回归分析,明确其区域差异。结果:单因素Logistic回归分析中,新生儿听力普遍筛查的比值比(OR)为5.481(强联系强度),在东西部地区间有统计学差异(P<0.01);经济负担的OR值为3.521(强联系强度),两地区间比较有统计学差异(P<0.01);沟通障碍的OR值为0.566(中等联系强度),两地区间比较无统计学差异(P>0.05);患儿来自城市或农村的OR值为1.128(无联系),两地区间比较无统计学差异(P>0.05)。多因素Logistic回归分析结果表明,新生儿听力普遍筛查和经济负担在两地区间有统计学差异,P值分别为0.000和0.040。结论:新生儿听力普遍筛查和经济因素在东西部地区存在明显差别,促进西部地区人工耳蜗早期植入,需要新生儿听力普遍筛查的更大范围的有效普及,也需要政府和社会的政策财政支持。

Objective：To describe the regional different factors which impact on early cochlear implantation in prelingual deaf children between eastern and western regions of China.Method：The charts of 113 children who received the cochlear implantation after 24 months old were reviewed and analyzed.Forty-five of them came from the eastern region（Jiangsu,Zhejiang or Shanghai）while 68 of them came from the western region（Ningxia or Guizhou）.Parental interviews were conducted to collect information regarding the factors that impact on early cochlear implantation.Result：Based on the univariate logistic regression analysis,the odds ratio（OR）value of universal newborn hearing screening（UNHS）was 5.481,which indicated the correlation of UNHS with early cochlear implantation is significant.There was statistical difference between the 2groups（P〈0.01）.For the financial burden,the OR value was 3.521（strong correlation）and there was statistical difference between the 2groups（P〈0.01）.For the communication barriers and community location,the OR value was 0.566 and 1.128 respectively,and there was no statistical difference between the 2groups（P〉0.05）.The multivariate analysis indicated that the UNHS and financial burden are statistically different between the eastern and westernregions（P=0.000 and 0.040respectively）.Conclusion：The UNHS and financial burden are statistically different between the eastern and western regions.To promote the early cochlear implantation in prelingual deaf children,the UNHS should be reinforced in the western region.In addition,the government and society should provide powerful policy and more financial support in the western region of China.The innovation of management system is also helpful to the early cochlear implantation.