本文關鍵詞： 長潛伏期聽覺誘發(fā)電位 短音 客觀測聽 聽閾 法醫(yī)學　出處：《中國醫(yī)科大學》2009年碩士論文　論文類型：學位論文

【摘要】： 前言 在法醫(yī)學鑒定中,聽力損害是以言語頻率(即500Hz,1000Hz和2000Hz)純音氣導聽閾均值的分貝數(shù)作為評定的依據(jù),目前由短聲(click)誘發(fā)的聽覺腦干誘發(fā)電位(auditory brainstem response,ABR)是聽覺誘發(fā)電位(Auditory EvokedPotentials,AEP)檢查法中應用最廣,技術也最為成熟的客觀測聽方法。但短聲誘發(fā)ABR主要反映2kHz以上高頻聽閾情況,不能很好反映中低頻率的聽閾,而且只能夠反應腦干以及腦干以下聽覺通路的功能狀況,因此單獨應用ABR反應閾推測言語頻率行為聽閾的方法,不能夠準確反映受試者不同頻率聽力損失的真實情況。為此,針對不同頻率短音誘發(fā)的AEP與不同頻率純音主觀聽閾之間關系,一些學者研究發(fā)現(xiàn)短音誘發(fā)的短、中、長潛伏期聽覺誘發(fā)電位具有較好的頻率特異性,可以用于不同頻率聽力損失的評價。但有關應用ALR客觀評定聽功能障礙方面的研究目前國內(nèi)外報道較少,特別是在法醫(yī)學上應用尚屬空白。 本研究通過對45名78耳受試者純音主觀聽閾、短音主觀聽閾和短音ALR反應閾的測試,進而研究短音ALR反應閾與純音主觀聽閾之間的關系及其影響因素,旨在分析和評價ALR的法醫(yī)學應用價值。 試驗對象與方法 一、試驗對象 試驗對象:主觀檢查配合的受試者45名(78耳),分為正常組、耳聾組和腦挫裂傷組。正常組20名(40耳)均為在校大學生,其中男性和女性各10名,平均年齡25.9歲,各頻率(500Hz、1000Hz、2000Hz和4000Hz)的純音氣導聽閾均＜25dB。耳聾組17名(22只聾耳),男性10名,女性7名,其中雙耳聾5名(10只聾耳),單耳聾12名,傳導性耳聾6名,感音神經(jīng)性聾11名。耳聾的判定:主訴耳聾,并經(jīng)純音測聽和ABR證實。耳聾范圍:35dB～90dB(ABR預估值)。腦挫裂傷組8名,其中男性6名,女性2名,年齡19～55歲,各頻率的純音氣導聽閾均＜25dB。腦挫裂傷的診斷均由頭CT和/或MRI片確認。 試驗方法:檢查在隔音室內(nèi)進行,依次測試受試者500Hz、1000Hz、2000Hz和4000Hz的純音主觀聽閾、短音主觀聽閾和短音ALR反應閾。當測試純音主觀聽閾時,采用FONMXFA—12型純音聽力計,頻率范圍:125Hz～8000Hz,最小輸出:-10dB,最大輸出:110dB。當測試短音主觀聽閾和短音ALR反應閾時,采用美國Nicolet Compact Four公司生產(chǎn)的多功能電生理記錄儀做為描記系統(tǒng),由TDH—39P型耳機給聲,電極為銀盤電極,記錄電極放置在顱頂中央中點(Cz),參考電極放置在同側耳垂內(nèi)側(A_1,A_2),接地電極放置在額極中點(Fp_z),每個電極阻抗＜5kΩ,極間電阻差＜3kΩ。描記ALR各反應波時,正常組由80dB開始,耳聾組由110dB開始,然后以每10dB為一檔遞減,接近反應閾時按5dB一檔下降,直至反應波形消失,重復記錄2次。每測定ALR一個頻率休息5～10分鐘。最后用X—Y記錄儀記錄。 結果 1、典型的ALR一般包括5個波,P1、N1、P2、N2和P3。其中N1、P2波波幅最大,出現(xiàn)率為100%,將誘發(fā)出ALR N1、P2波的最小聲強確定為短音ALR反應閾。 2、在500Hz、1000Hz、2000Hz和4000Hz四個頻率上,正常組短音ALR反應閾與純音主觀聽閾之差的均值和標準差分別為7.33±3.12dB、8.11±2.62dB、7.22±2.50dB、9.19±2.85dB;短音主觀聽閾與純音主觀聽閾之差的的均值和標準差分別為3.48±2.17dB、4.33±2.36dB、4.07±1.78dB、3.96±2.21dB;短音ALR反應閾與短音主觀聽閾之差的均值和標準差分別為3.85±2.27dB、3.78±1.83dB、3.15±2.14dB、5.22±2.04dB。 3、在500Hz、1000Hz、2000Hz和4000Hz四個頻率上,短音ALR反應閾與純音主觀聽閾的回歸方程分別是Y=0.87x-4.18、Y=0.91x-6.49、Y=0.6x-1.21、Y=0.99x-9.03。經(jīng)t檢驗,P＜0.01。 4、在500Hz、1000Hz、2000Hz和4000Hz四個頻率上,耳聾組短音ALR反應閾與純音主觀聽閾之差的均值和標準差分別為7.00±3.08dB、8.14±2.57dB、7.37±2.79dB、9.45±3.02dB;短音主觀聽閾與純音主觀聽閾之差的均值和標準差分別為3.56±2.58dB、4.24±2.46dB、4.18±2.01dB、4.03±2.33dB;短音ALR反應閾與短音主觀聽閾之差的均值和標準差分別為4.01±2.34dB、3.88±1.97dB、3.05±2.17dB、5.27±2.39dB。對耳聾組與正常組ALR反應閾與純音主觀聽閾的差值進行t檢驗,二者無顯著性差異(P＞0.05)。 5、在500Hz、1000Hz、2000Hz和4000Hz四個頻率上,腦挫裂傷組短音ALR反應閾與純音主觀聽閾之差的均值和標準差分別為7.21±3.21dB、8.21±2.31dB、7.02±2.91dB、9.53±3.27dB;短音主觀聽閾與純音主觀聽閾之差的的均值和標準差分別為3.38±2.76dB、4.11±2.27dB、4.02±2.14dB、4.01±2.43dB;短音ALR反應閾與短音主觀聽閾之差的均值和標準差分別為3.92±2.12dB、3.96±2.07dB、3.11±2.18dB、5.47±2.22dB。對腦挫裂傷組與正常組ALR反應閾與純音主觀聽閾的差值進行t檢驗,二者無顯著性差異(P＞0.05)。對腦挫裂傷組與正常組的ALRN1、P2波潛伏期和波幅進行t檢驗,N1和P2均無顯著性差異(P＞0.05)。 6、隨著刺激聲強的增高,不同頻率ALRN1、P2波的潛伏期縮短,波幅增高。 7、在500Hz、1000Hz、2000Hz和4000Hz四個頻率上,ALR反應閾與純音主觀聽閾的差值86.25%小于10dB。因此,應用ALR反應閾預估純音主觀聽閾時,保守的估計是ALR反應閾減去(0～10dB),即純音主觀聽閾的預估值范圍。 結論 1、典型的ALR一般包括5個波,P1、N1、P2、N2和P3波。其中N1、P2波波幅最大,出現(xiàn)率為100%。N1、P2波的反應閾、潛伏期和波幅是ALR的主要觀察指標。 2、隨著刺激聲強的增高,不同頻率ALRN1、P2波的潛伏期縮短,波幅增高。 3、試驗結果發(fā)現(xiàn),在同一聲強下,1000Hz和2000Hz的潛伏期較短,波幅較高。 4、ALR具有頻率特異性、接近主觀聽閾,能夠反應整個聽覺通路的功能狀況。對不同性質(zhì)耳聾和腦挫裂傷(無聽力障礙)受試者可以進行評定。 5、由于ALR屬于皮層電反應,因此,為得到較好的ALR波形,受試者在測試中必須保持清醒狀態(tài)。
[Abstract]:Preface
In the forensic identification, is based on the speech frequency hearing impairment (i.e. 500Hz, 1000Hz and 2000Hz) pure tone air conduction threshold average decibel as assessment basis, the short sound (click) evoked by brainstem auditory evoked potential (auditory brainstem response ABR (Auditory) is the auditory evoked potential EvokedPotentials, the AEP) wide application of check method, technology is the most mature objective audiometry method. But the short sound evoked ABR mainly reflects the above 2kHz high frequency, cannot reflect the low frequency threshold, and only able to response the brainstem and brainstem auditory pathway following functional status, therefore the single application of ABR speech frequency threshold speculation behavior the threshold, can not accurately reflect the real situation of the subjects of different frequency hearing loss. Therefore, according to the different frequency tone PIP evoked AEP and different subjective relationship between the frequency of pure tone threshold, a Some scholars found that Tone Pip evoked short and long latency auditory evoked potentials with good frequency specific, can be used for the evaluation of different frequency hearing loss. But the application of ALR to study the function of objective evaluation at home and abroad is rarely reported, especially in the application of forensic medicine is still blank.
This study of 45 ears of 78 subjects pure tone thresholds, short and short subjective threshold ALR threshold test, and study the relationship between the factors of short ALR thresholds and pure tone thresholds and their influence to forensic analysis and evaluation of ALR applications.
Test object and method
First, the test object
Participants: Participants' subjective examination combined with 45 (78 ears), were divided into normal group, deafness group and cerebral contusion group. 20 normal subjects (40 ears) were college students, male and female each 10, the average age of 25.9 years, the frequency of (500Hz, 1000Hz, 2000Hz 4000Hz) and pure tone air conduction threshold < 25dB. deafness group 17 (22 ears), 10 males and 7 females, including 5 double deafness (10 ears), 12 single deafness, 6 conductive deafness, sensorineural deafness decision: 11. Complained of deafness, and by pure tone audiometry and ABR deafness confirmed. Range: 35dB ~ 90dB (ABR estimate). Cerebral contusion Group 8, male 6, female 2, age 19~55 years, diagnosis of various frequency pure tone air conduction hearing thresholds were less than 25dB. in brain contusion were from CT and / or MRI confirmed.
Test method: check in indoor noise, followed by test subjects 500Hz, 1000Hz, 2000Hz and 4000Hz of the pure tone thresholds, short and short subjective threshold ALR threshold. When the test of pure tone thresholds, using FONMXFA - 12 type audiometer, frequency range: 125Hz ~ 8000Hz, the minimum output: -10dB, maximum output: 110dB. when the test is short and short sound subjective threshold ALR threshold, using the United States Nicolet Compact Four company production of multifunctional electric physiological recorder for recording system by TDH - type 39P headset to sound, as the silver electrode electrode and recording electrode placed on the parietal central point (Cz), reference electrode placement in the ipsilateral medial lobe (A_1, A_2), the ground electrode placed at the midpoint of the frontal pole (Fp_z), each electrode impedance < 5K, resistance difference between 3K. ALR wave tracings of the reaction, the normal group started by 80dB, the deaf group started by 110dB, then every 10 DB decreased for the first gear. When it approached the reaction threshold, it fell down according to the first gear of 5dB, until the reaction waveform disappeared, repeated 2 times. Every ALR frequency was measured for 5~10 minutes. Finally, it was recorded by X Y recorder.
Result
1, the typical ALR generally includes 5 wave, P1, N1, P2, N2 and P3. in N1, P2 wave amplitude is maximum, the occurrence rate of 100%, will be induced by ALR N1, P2 wave minimum sound intensity to determine the short ALR threshold.
In 2, 500Hz, 1000Hz, 2000Hz and 4000Hz four frequencies, normal group mean and standard short ALR thresholds and pure tone thresholds of the difference between the difference was 7.33 + 3.12dB, 8.11 + 2.62dB, 7.22 + 2.50dB, 9.19 + 2.85dB; s subjective threshold and pure tone thresholds of the difference between the mean value and the standard deviation was 3.48 + 2.17dB, 4.33 + 2.36dB, 4.07 + 1.78dB, 3.96 + 2.21dB; the mean and standard short ALR thresholds and short subjective hearing threshold difference difference were 3.85 + 2.27dB, 3.78 + 1.83dB, 3.15 + 2.14dB, 5.22 + 2.04dB.
In 3, 500Hz, 1000Hz, 2000Hz and 4000Hz four frequencies, regression equation of short ALR thresholds and pure tone thresholds were Y=0.87x-4.18, Y=0.91x-6.49, Y=0.6x-1.21, Y=0.99x-9.03. by t test, P < 0.01.
In 4, 500Hz, 1000Hz, 2000Hz and 4000Hz four frequency, mean and standard deafness group short ALR thresholds and pure tone thresholds of the difference between the difference was 7 + 3.08dB, 8.14 + 2.57dB, 7.37 + 2.79dB, 9.45 + 3.02dB; the mean and standard short subjective threshold and pure tone thresholds of the difference between the difference were 3.56 + 2.58dB, 4.24 + 2.46dB, 4.18 + 2.01dB, 4.03 + 2.33dB; the mean and standard short ALR thresholds and short subjective hearing threshold difference difference were 4.01 + 2.34dB, 3.88 + 1.97dB, 3.05 + 2.17dB, 5.27 + 2.39dB. difference of deafness group and the normal group ALR thresholds and pure tone thresholds the T test, there was no significant difference between the two (P > 0.05).
In 5, 500Hz, 1000Hz, 2000Hz and 4000Hz four frequency, mean and standard of group short ALR thresholds and pure tone thresholds of the difference between the difference of cerebral contusion were 7.21 + 3.21dB, 8.21 + 2.31dB, 7.02 + 2.91dB, 9.53 + 3.27dB; s subjective threshold and pure tone thresholds of the mean and standard deviation the difference was 3.38 + 2.76dB, 4.11 + 2.27dB, 4.02 + 2.14dB, 4.01 + 2.43dB; the mean and standard short ALR thresholds and short subjective hearing threshold difference difference were 3.92 + 2.12dB, 3.96 + 2.07dB, 3.11 + 2.18dB, 5.47 + 2.22dB. difference on cerebral contusion group and the normal group ALR reaction threshold and pure subjective threshold for t testing, there was no significant difference between the two (P > 0.05). The cerebral contusion group and normal group ALRN1, the latency and amplitude of P2 were analyzed by t test, there were no significant differences between N1 and P2 (P > 0.05).
6, with the increase of the intensity of the stimulus, the latency of the P2 wave was shortened and the amplitude of the wave increased at different frequencies of ALRN1.
In 7, 500Hz, 1000Hz, 2000Hz and 4000Hz four frequency, 86.25% ALR difference thresholds and pure tone thresholds of less than 10dB.. Therefore, application of ALR threshold prediction of pure tone thresholds, a conservative estimate is subtracted from the ALR threshold (0 ~ 10dB), the pure subjective threshold pre valuation range.
conclusion
1, the typical ALR generally includes 5 waves, P1, N1, P2, N2 and P3 waves. N1, P2 wave amplitude is the largest, the rate of occurrence is 100%.N1, the threshold, latency and amplitude of P2 wave are the main indicators of ALR.
2, with the increase of the intensity of the stimulus, the latency of the P2 wave was shortened and the amplitude of the wave increased at different frequencies of ALRN1.
3, the experimental results show that, under the same sound intensity, the latency of 1000Hz and 2000Hz is shorter and the amplitude of wave is higher.
4, ALR has the frequency specificity, close to the subjective threshold, can reflect the functional status. The auditory pathway for different deafness and cerebral contusion (without hearing impairment) subjects can be assessed.
5, since ALR is a cortical electrical response, in order to get a better ALR waveform, the subjects must remain awake in the test.

【學位授予單位】：中國醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2009
【分類號】：D919.4

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