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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

魏薇;文骏雄;胡月;董耀东;刘东亮;马忠良;刘晶;关丽华;马秀岚;

1:中国医科大学附属盛京医院耳科

2:辽宁省残疾人康复中心

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摘要

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。

关键词

人工耳蜗植入;语言能力;发展规律

基金项目(Foundation):

国家自然科学基金青年科学基金项目(81800904);; 辽宁省教育厅科学技术研究项目(LK201647);; 沈阳市科学计划项目(18-014-4-09)

作者

魏薇;文骏雄;胡月;董耀东;刘东亮;马忠良;刘晶;关丽华;马秀岚;

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