人工耳蜗植入者的生活质量、自尊与社会融合：罗马尼亚一家三级中心的横断面研究

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中文摘要

背景与目的： 人工耳蜗植入后的结局通常采用听力学指标来评判，但植入者的日常获益还取决于心理和社会功能。本研究描述了在罗马尼亚一家三级中心随访的人工耳蜗植入者在六个患者报告领域的植入后生活质量（QoL），并探讨了与社会融合相关的因素。方法：在这项横断面研究中，50名连续的人工耳蜗植入者（24名儿童和青少年，26名成人）完成了一份经过验证的35项罗马尼亚语问卷，涵盖言语感知、心理自尊、媒体与音乐、环境声音、聆听努力和社会融合，最小儿童由家长代理完成。各领域得分转换为0-100分。亚组比较采用基于秩的检验，与社会融合的关联采用Spearman相关和探索性多变量回归进行分析。结果：总体生活质量中位得分为67.1（四分位距，53.6-77.9）。媒体与音乐得分最高（中位数85.7），聆听努力最低（中位数56.2）；心理自尊中位数为66.7（四分位距，50.0-79.2）。生活质量得分在性别、年龄组、植入后时间、手术入路或SMART NAV使用方面无显著差异，尽管若干亚组分析检验效能不足。心理自尊与社会融合的相关性最强（rho = 0.56，p < 0.001），并且在探索性多变量模型中，是唯一p < 0.05的预测因子（B = 0.456，95% CI，0.117-0.795；p = 0.010；R2 = 0.428）。结论：在该队列中，植入后生活质量在不同功能领域存在差异，聆听努力仍是一个相对挑战。社会融合与心理自尊的关联比与单个听觉领域的关联更为密切。这些发现具有探索性，需要在更大规模、包含植入前测量的纵向研究中加以证实。

英文摘要

Background and Objectives: Outcomes after cochlear implantation are usually judged using audiological measures, although recipients' everyday benefit also depends on psychological and social functioning. This study characterized post-implant quality of life (QoL) across six patient-reported domains in cochlear implant recipients followed at a tertiary center in Romania and explored factors associated with social integration. Methods: In this cross-sectional study, 50 consecutive cochlear implant recipients (24 children and adolescents, 26 adults) completed a validated 35-item Romanian-language questionnaire covering speech perception, psychological self-esteem, media and music, environmental sound, listening effort, and social integration, with parent-proxy completion for the youngest children. Domain scores were transformed to a 0-100 scale. Subgroup comparisons used rank-based tests, and associations with social integration were examined with Spearman correlations and an exploratory multivariable regression. Results: The median overall QoL score was 67.1 (interquartile range, 53.6-77.9). Media and music scored highest (median 85.7) and listening effort lowest (median 56.2); psychological self-esteem had a median of 66.7 (interquartile range, 50.0-79.2). QoL scores did not differ significantly by sex, age group, time since implantation, surgical approach, or SMART NAV use, although several subgroup analyses were underpowered. Psychological self-esteem showed the strongest correlation with social integration (rho = 0.56, p < 0.001) and was the only predictor with p < 0.05 in the exploratory multivariable model (B = 0.456, 95% CI, 0.117-0.795; p = 0.010; R2 = 0.428). Conclusions: In this cohort, post-implant QoL varied across functional domains, with listening effort remaining a relative challenge. Social integration was more closely associated with psychological self-esteem than with individual auditory domains. These findings are exploratory and require confirmation in larger longitudinal studies with pre-implant measurements.