广东省人工耳蜗康复救助项目实施成效分析

The Efficacy of the Cochlear Implant Assistance Program in Guangdong Province

目的研究分析广东省人工耳蜗康复救助项目（以下简称项目）的实施成效，为项目进一步开展提供参考。方法对参与项目工作的17个定点康复机构、5家定点医院，658名受助者监护人进行问卷调查和访谈，对受助者术前、术后各阶段的听觉言语状况等进行评估以及跟踪康复走向。结果2007～20l3年，项目共受理申报2183人，受助者共658人，受助率为30．1％，年龄小于7岁的占91．6％。658名受助者术后听觉言语能力进步明显，其韵母、声母、双音节词三项平均识别率从术前的10．6％提高到开机12个月时的73．5％，语法能力、理解能力、交往能力三项平均语言年龄从0．4岁提高到2．3岁；189例术后满3年者其听觉行为分级平均从1．1级提高到6．1级，言语可懂度分级平均从1．1级提高到4．0级；208例术后满2年以上者有74．0％入读普校或普幼。大部分被调查者认为项目受助者术后康复效果比较满意，参与项目工作的定点机构工作人员和受助者监护人对项目工作整体评价也比较满意。结论项目已形成相对完善的工作机制，成效显著，社会效益良好，但仍存在救助指标有限、申请程序繁琐、工作流程比较长、救助产品无法满足个体化需求以及项目服务能力和服务水平仍有待进一步提高等困难和问题。

Objective To evaluate the efficacy of Cochlear Implant Assistance Program in Guangdong Province in order to provide more evidences for the further implementation of the program. Methods The questionnaire survey and interview were performed to 17 rehabilitation institutions, 5 hospitals and 658 guardians to assess the auditory and speech abilities of the cochlear implant recipients before and after the cochlear implantation and to investigate the rehabilitation outcome. Results From 2007 to 2013, a total of 2183 people applied for the program, with a recipient rate of 30.1%. The recipients were mainly young children with 91.6% younger than 7 years old. The 658 recipients made significant progress in auditory and speech abilities after the operation. One year after the operation, the average speech recognition rate of vowels, consonants and bisyllable words increased from 10.6% to 73.5% and the average language age of grammatical, understanding and communicative abilities increased from 0.4 to 2.3 years. For 189 recipients, the categories of auditory performance （CAP） was improved from 1.1 to 6.1 and the speech intelligibility rating （SIR） was improved from 1.1 to 4.0 three years after the operation. For 208 children who received two years of rehabilitation training, 74.0% went to the regular schools or kindergartens. Most of the respondents were satisfied with the program. Conclusion This program has established a relative complete operational mechanism and received remarkable achievements and excellent social benefits. However, there are still some difficulties and problems such as inadequate assistance index, complex application procedures, limited cochlear products and insufficient service ability.