语前聋患儿人工耳蜗植入后三年内语言能力发展规律

The Language Ability Development of Pre-lingually Deaf Children within Three Years after the Cochlear Implantation

目的探讨语前聋患儿人工耳蜗植入(cochlear implant, CI)后3年内语言能力发展规律。方法以371例语前聋CI术后患儿为研究对象,植入年龄1~7岁,平均植入年龄3.02±1.60岁,分别于入训时(即开始康复训练时)及训练后6、12、18、24、30、36个月时进行语言清晰度、语法能力、理解能力、表达能力和交往能力共五项语言能力评估,同时进行听觉行为分级(categories of auditory performance, CAP)和言语可懂度分级(speech intelligibility rating, SIR)评估。结果①患儿的五项语言能力发展均随时间延长呈同步增长趋势,入训时及训练后6、12、18、24、30、36个月时语言清晰度年龄分别为0.59±0.87、1.49±1.00、2.33±1.06、3.13±0.96、3.71±0.74、3.83±0.46、3.90±0.35岁,语法能力年龄分别为0.73±1.03、1.58±1.09、2.55±1.20、3.20±0.93、3.58±0.72、3.83±0.45、3.92±0.32岁,理解能力年龄分别为0.80±1.10、1.82±1.16、2.97±1.14、3.42±0.82、3.72±0.60、3.87±0.40、3.96±0.22岁,表达能力年龄分别为0.48±0.83、1.31±1.03、2.18±1.13、3.11±0.92、3.53±0.71、3.82±0.47、3.92±0.29岁,交往能力年龄分别为0.54±0.88、1.27±0.99、2.23±1.13、3.07±0.94、3.50±0.75、3.82±0.47、3.93±0.39岁,且前12个月增长速度最快(P<0.05),发展顺序依次为理解能力、语法能力、语言清晰度、表达能力、交往能力,其中理解能力发展速度明显先于其他四种语言能力(P<0.05);②五项语言能力发展速度随着时间延长逐渐变缓,其中语言清晰度、表达能力、交往能力在第30个月之前两两时间点之间比较差异有统计学意义(P<0.05);语法能力和理解能力在第24个月之前两两时间点之间比较差异有统计学意义(P<0.05);③入训时及训练后6、12、18、24、30、36个月时CAP平均分级分别为0.85±0.80、2.18±1.00、3.37±1.13、4.62±1.22、5.43±1.10、6.13±0.84、6.61±0.67级,SIR平均分级分别为1.16±0.50、1.81±0.78、2.84±0.87、3.70±0.87、4.21±0.77、4.56±0.57、4.81±0.43级,总体语言年龄与CAP及SIR分级均呈显著正相关(P<0.05)。结论随着CI时间的延长,语前聋患儿逐渐建立听觉语言能力,且语言理解能力增长速度最快,建议术后听觉言语康复时间不少于30个月。

Objective To investigate the development of the speech ability of deaf children with cochlear implantation(CI)within 3 years'follow-up.Methods Language articulation,grammatical competence,comprehension competence,expression competence and communicative competence were used to evaluate 371 CI children with a mean age of 3.02 yr for the rehabilitation training at intervals of 6,12,18,24,30,and 36 months.The categories of auditory performance(CAP)and speech intelligibility rating(SIR)were also used to analyze the changes.Results All the language abilities had increased along with the ongoing rehabilitation training,which the first 12 months showed the fastest increase(P<0.05).The developmental order was comprehension competence,grammatical competence,language articulation,communicative competence,and expression competence.Among them,comprehension competence was significantly faster than the other four abilities(P<0.05).The language abilities became slower with time,and language articulation,expression competence,communicative competence showed significant differences between each two points before 30 th month(P<0.05).Grammatical competence and comprehensive competence had significant differences between each two point before 24 th month(P<0.05).The average language ability was positively related to CAP and SIR(P<0.05).Conclusion The CI children demonstrated the gradually improved hearing and language abilities through rehabilitation.According to the different times of 5 language abilities reaching their plateau,it is suggested that more than 30 months training should be used for better results in hearing and language rehabilitation.