儿童电刺激皮层听觉诱发电位P1-N1-P2的参数优化研究

Optimization of Electrically Evoked Cortical Auditory Potentials P1-N1-P2 Test Parameters in Pediatric Patients

目的比较不同刺激位点、脉宽、速率条件下儿童人工耳蜗植入(cochlear implants,CIs)患者电诱发皮层听觉诱发电位(electrically evoked cortical auditory evoked potential,eCAEP)P1-N1-P2的特点,选择优化的参数,为eCAEP进入临床应用提供进一步依据。方法对20名儿童CI患者进行eCAEP测试,记录并分析不同刺激位点(#4,#13,#20)、脉宽(50μs,100μs,200μs)、速率(0.2Hz,0.9Hz,1.6Hz)下P1-N1-P2波形的引出率、阈值、潜伏期、振幅。结果在内耳及蜗神经结构正常的16名患儿中,①脉宽为100,200μs时的P1引出率均为100.00%,显著高于脉宽为50μs时的P1引出率80.00%(P<0.05)。脉宽50μs时平均阈值为(125.83±28.43)CL,显著高于脉宽100μs时阈值(102.50±25.63)CL(P<0.01)及脉宽200μs阈值(95.00±16.79)CL(P<0.01)。②刺激速率对引出率无显著影响(P>0.05)。刺激速率为0.2Hz时平均阈值为(87.14±24.31)CL,明显低于速率为0.9Hz时阈值(98.57±19.56)CL(P<0.05)及1.6Hz时阈值(100.71±23.69)CL(P<0.05)。③刺激位点对引出率、阈值无显著影响(P>0.05)。不同刺激位点下P1引出率均为100%,N1-P2引出率均大于85%。结论CI儿童的电刺激P1-N1-P2 CAEP波形引出率高,便于临床检测。其中,P1波引出率最高,可以作为主要观察波形。刺激速率0.9~1.6Hz、脉宽100~200μs为推荐刺激参数。当引出率欠佳、波形分化差时,可考虑增加脉宽、降低刺激速率以获得最佳的P1-N1-P2反应。

Objective To report effects of stimulation location,pulse width and stimulus rate on the electrically evoked cortical auditory potentials(eCAEP)P1-N1-P2 in children with cochlear implants(CIs),to optimize stimulation parameters for P1-N1-P2 for further clinical use.Methods P1-N1-P2 responses were recorded in 20 prelingually deaf pediatric CI recipients.The rate of response detection,and response threshold,latency and amplitude of P1-N1-P2 were recorded for burst stimulation at different electrode array locations(#4,#13,#20),with varying pulse widths(50μs,100μs and 200μs)and repetition rates(0.2Hz,0.9Hz and 1.6Hz).Results In the 16 CI recipients with the normal inner ear and auditory nerve imaging,the rate of P1 response was 100.00%for pulse widths of 100μs and 200μs and 80.00%for pulse widths of 50μs(P<0.05).The mean threshold was 125.83±28.43 CL,102.50±25.63 CL and 95.00±16.79 CL CL for pulse widths of 50μs,100μs and 200μs,respectively,(P<0.05).The repetition rates had no significant effect on the detection rate of P1-N1-P2(P>0.05).The mean threshold was 87.14±24.31 CL at 0.2Hz,lower than thresholds at 0.9Hz(98.57±19.56 CL,P<0.05)and 1.6 Hz(100.71±23.69 CL,P<0.05).Stimulation location had no significant effect on the P1-N1-P2 responses(P>0.05).The rate of P1 detection was 100%and the rate of N1-P2 detection was above 85%at all stimulation locations.Conclusion P1-N1-P2 can be reliably induced in CI recipients,convenient for clinical testing.P1 can always be induced and used as a promising biomarker.Recommended stimulation parameters include a repetition rate of 0.9~1.6 Hz and a pulse width of 100μs.When morphology of responses is poor,increasing stimulus pulse width and reducing repetition rate should be considered to improve responses.