【作者】 肖琨；

【导师】 张学渊；

【作者基本信息】 第三军医大学 ， 耳鼻咽喉科学， 2007， 硕士

【摘要】 目的:电诱发听觉脑干反应(electrically evoked auditory brainstem responses,EABR)是一种能够客观反映听觉神经系统功能状态的电生理测试方法。在EABR测试中,不同的刺激参数会引起EABR波形的变化。本实验的目的是研究不同刺激模式对人工耳蜗植入术后EABR波形和阈值的影响,为临床测试人工耳蜗植入者的EABR选择适宜的刺激模式提供参考;同时选择与记录电诱发听神经复合动作电位(ECAP)相同的刺激脉宽,比较两种阈值间的相关性。方法:对9名Nucleus 24M人工耳蜗植入患者术后调试言语处理器时分别测试电极E3,E10,E20(分别代表蜗底、蜗中、蜗顶)的ECAP阈值和在不同刺激模式(MP1+2、MP1、MP2、BP+1、CG)下的EABR阈值,比较EABR阈值和ECAP阈值间的关系。比较分析强度为200～255电流级(current level,CL)(约阈上30电流级)刺激时各电极在五种刺激模式下引出的EABRⅢ波和Ⅴ波引出率、潜伏期及其幅值。结果通过统计学软件SPSS13.0进行均数间比较和相关回归分析。结果:①电极3,10,20的ECAP阈值(CL)分别为197.88±12.21,195.23±9.97,182.03±12.08;EABR阈值(CL)分别为200.9±16.4,197.8±11.8,185.1±20.8。在EABR阈值和EABR阈值中,电极20的阈值均低于电极3和10的阈值,前者与后两者间存在统计学差异。②MP1+2,MP1,MP2,BP+1,CG模式下EABRV波检出率分别为96.3%,94.4%,96.3%,14.8%,33.3%,单极(monopolar)模式下(MP1+2,MP1,MP2)的Ⅴ波检出率比双极(bipolar)(BP+1)和共地(common ground)模式(CG)高(P=0.010＜0.05,P=0.018＜0.05)。③MP1+2,MP1,MP2,BP+1,CG模式Ⅲ波检出率分别为62.96%,59.26%,66.67%,14.81%,18.52%,电极3,10,20的Ⅲ波检出率分别为22.22%,42.22%,68.89%。单极模式下的Ⅲ波检出率比双极模式和共地模式高(P＜0.05)。电极20的Ⅲ波检出率高于电极3和电极10(P＜0.05)。④MP2刺激模式下Ⅲ波平均潜伏期为2.06ms,电极3,10,20的潜伏期分别为2.11±0.46ms,2.07±0.86ms,2.03±0.12ms,三个电极间无统计学差异(F=0.719,P=0.503＞0.05)。⑤MP1+2刺激模式下,电极3,10,20的Ⅴ波潜伏期分别为4.09±0.16ms,4.02±0.19ms,3.70±1.21ms,蜗顶的Ⅴ波潜伏期短于蜗中和蜗底(P=0.026,P=0.004)。电极3、10、20的振幅(μv)分别为0.46±0.31,0.44±0.25,0.74±0.35,电极20的EABRⅤ波振幅均值明显高于其他两个电极。单极刺激模式比双极和共地刺激模式获得的平均EABR振幅大,MP1与CG(P=0.039＜0.05)和MP2与CG(P=0.027＜0.05)之间存在统计学差异。⑥五种刺激模式下的EABR阈值(CL)分别为193.6±12.5,190.3±13.0,189.3±12.2,207.5±44.4,234.0±8.2,单因素方差分析显示CG与MP1、MP2、MP1+2间存在统计学差异(P=0.000＜0.01,P=0.000＜0.01,P=0.000＜0.01),共地刺激模式CG的EABR阈值明显高于单极刺激模式;而单极刺激模式MP1+2与MP1,MP1+2与MP2,MP1与MP2间EABR阈值无统计学差异(P=0.0987＞0.05,P=0.0915＞0.05,P=1.000＞0.05)。⑦ECAP阈值与EABR阈值Pearson相关系数为0.974(P＜0.01),回归方程为EABR=8.696+0.94×ECAP,两者进行配对t检验,结果显示无显著差异(t=5.377,df=25,P＞0.05)。⑧本实验同时采用了同侧和对侧记录,发现同侧记录的波形和对侧记录的波形相似,部分反而更清晰,波形分化更好,随刺激强度的下降Ⅴ波消失稍晚。结论:人工耳蜗植入术患者术后单极刺激下易检测出EABR波形,检出率高,波形分化较好,波幅大,而采用双极及共地模式EABR阈值较高或难以引出波形。同侧记录的波形有时较对侧更清晰可辨,波幅更大。研究认为在对人工耳蜗植入患者术后进行EABR测试时可首选单极刺激模式,从易诱发出振幅较大的波形的蜗顶电极开始,并且有可能的话进行同侧与对侧同时记录。更多还原

【Abstract】 OBJECTIVE:In very young children with cochlear implant,objective measures play a vital role both before and after implantation.The most promising method is the registration of electrically evoked auditory hrainstem response(EABR).For effective use of EABRs it is important to determine the characteristic EABR changes due to the stimulation parameters.Our general objective was to investigate the impact of stimulation mode on morphology of EABR,and to compare the thresholds of EABR and electrically evoked compound action potential(ECAP) with the same pulse width of probe stimulation.METHOD:3 electrodes of 9 Nucleus 24M cochlear implant users,along the electrode array from base towards apex,were stimulated for ECAP and EABR registration.EABRs were recorded in MP1+2、MP1、MP2、BP+1,CG stimulation mode respectively.EABR waveⅢ、V appearace frequency、peak latency and amplitude were compared between 3 electrodes as well as between different stimulation modes.The relationship between EABR and ECAP thresholds were analysised with SPSS13.0.RESULTS:①ECAP threshold and EABR threshold of E3,E10,E20 was 197.88±12.21vs.200.9±16.4,195.23±9.97vs.197.8±11.8,182.03±12.08vs.185.1±20.8 respectively.The thresholds of E20 were lower than those of E30 and E10 with significant difference.②EABR wave V appearance frequency was 96.3%,94.4%,96.3%,14.8%,33.3% in MP1+2,MP1,MP2,BP+1,CG mode respectively.The appearance frequency in MP mode was higher than those in BP+1 and CG(P=0.010＜0.05,P=0.018＜0.05)③WaveⅢappearance frequency was 62.96%,59.26%,66.67%,14.81%,18.52% in MP1+2,MP1,MP2,BP+1,CG respectively.It was 22.22%,42.22%,68.89%in E3,E10,E20 respectively. ④The average waveⅢlatency was 2.06ms,and 2.11±0.46ms,2.07±0.86ms, 2.03±0.12ms in E3,E10,E20 respectively with no difference between 3 electrodes (F=0.719,P=0.503＞0.05).⑤In MP1+2 mode,waveⅤlatency of E3,E10,E20 was 4.09±0.16ms, 4.02±0.19ms,3.70±1.21ms,with shorter latency in apex(P=0.026,P=0.004).WaveⅤamplitude(μv)of E3,E10,E20 was 0.46±0.31,0.44±0.25,0.74±0.35.⑥EABR threshold(CL)was 193.6±12.5,190.3±13.0,189.3±12.2,207.5±44.4, 234.0±8.2 in MP1+2,MP1,MP2,BP+1,CG mode respectively,CG was significantly different with MP1、MP2、MP1+2(P=0.000＜0.01,P=0.000＜0.01,P=0.000＜0.01), with no difference between MP1,MP2,MP1+2(P=0.0987＞0.05,P=0.0915＞0.05, P=1.000＞0.05).⑦ECAP threshold was significantly correlated with EABR threshold(r=0.974,P＜0.01). A linear regression model was constructed as an equation:EABR=8.696+0.94×ECAP.A paired t-test indicated that there was no difference between them(t=5.377,df=25,P＞0.05).⑧Ipsilateral and contralateral recording were conducted simultaneously. Sometimes ipsilateral recorded waveforms had a better discrimination than contralateral counterparts.CONCLUSION:Monopolar stimulation mode exhibited advantage than bipolar and common ground mode in some respects.We recommend it as the first choice in EABR registration.What’s more,ipsilateral and contralateral simultaneous recording is also recommended for a better identification of EABR waveforms.更多还原