356例人工耳蜗植入儿童术后语言康复效果发展趋势研究

目的分析356例人工耳蜗植入儿童术后1年的语言能力发展趋势，为实施康复效果质量监控与进一步改善安置策略提供指导。方法依照人工耳蜗植入年龄进行分组，以术后不同的安置时段（3、6、9和12个月）为重复测量条件。采用方差分析方法，利用SPSS16．0软件评估不同年龄段人工耳蜗植入儿童术后安置1年内语言能力随时间顺序变量变化的趋势。结果①接受人工耳蜗植入的聋儿在术后1年安置中语言能力评估平均成绩（语言年龄）属地、性别差异不显著（P〉0．05）；②随着安置时段的延续，语言能力评估平均成绩（语言年龄）总体上呈线性（＊＊p=0．000〈0．01）和二次性（＊＊P=0．000〈0．01）上升变化的趋势③在语言能力（语言年龄）获得方面，2岁组与3岁组、4岁组与5岁组、5岁组与6岁组的变化趋势相近（P〉0．05），而7岁组与其他各组、3岁组与4岁以上组间变化趋势差异显著（＊P〈0．05）；④比例差异系数（coefficients of variation，CV）的比较显示，随着术后安置接受训练时间的延续，各年龄分组的语言能力（语言年龄）平均值的标准差变小，除了7岁组外其他年龄组的CV变异系数仍在20％以上。结论①通过对接受人工耳蜗植入的2～7岁聋儿语言能力的评估认为安置策略总体上是有效的，在语言能力（语言年龄）的获得上不存在属地和性别的差异；②在术后安置策略保持一致的情况下，人工耳蜗植入聋儿的语言康复效果，主要受到来自人工耳蜗植入年龄和术后接受康复训练时间长短两个要素的交互影响；③人工耳蜗植入不同年龄组间语言能力的发展速度，随着术后康复训练时间的延续出现非等速均匀发展的特点；④相对于听觉能力的发展，人工耳蜗植入不同年龄组聋儿语言能力的发展表现出缓慢性特征。

A Study on postoperative language development trends for 356 children with CI

Objective To analyze the trends for the language improvement of 356 children with CI over one year postoperative training and to provide the guidance for rehabilitation supervision and further implementation of postoperative rehabilitation strategies. Methods Children were grouped by the ages of cochlear implantation, and assessed at different postoperative periods （at 3, 6, 9 and 12 months respectively）. An analysis of variance was used to assess the language development trends within one year after CI operation for children of different age groups with SPSS16.0 software. Result （1）There were no significant differences in the language assessment scores of children one year after cochlear implantation between children from different regions and of different genders（P〉0.05）.（2）The language assessment scores （%） for children with CI showed a linear （＊＊P=0.000〈0.01）and quadratic （＊＊P=0.000〈 0.01 ）trend of increase within one year after the operation. （3） There were similar trends between 2 and 3-year-old group, 4 and 5-year-old group , 5 and 6-year-old groups （P〉0.05） in the acquisition of language ability. However, there were significant differences between 7-year- old group and the other groups, between 3-year-old group and the groups over 4 years old （＊m 〈0.05）. ~The comparison of coefficients of variation （CV） indicated that the average standard deviation of language assessment scores decreased over time of training. The CVs of all groups were over 20% except for the 7-year-old group. Conclusion （1） The language assessment results of 2-7-year-old children with CI have shown that the rehabilitation strategies are effective for hearing-impaired children. There were no regional and gender differences in language acquisition. When children with CI were given the same rehabilitation strategies, the ages of implantation and the training time were two key factors to imposing interactive influence on rehabilitation outcome. （3）The language ability development was non-uniform among different age groups as time went on. （4） The language abilities of children with CI developed relatively slowly as opposed to the development of hearing abilities.