置管保留并间断阻滞星状神经节治疗突发性耳聋的效果及安全性
发布时间：2018-08-11 09:02
【摘要】：目的:此研究是针对突发性单耳耳聋患者在给予舒血宁注射液、川芎嗪、维生素B12、糖皮质激素治疗的基础上,联合高压氧治疗,配合应用星状神经节置管保留,并间断应用0.1%罗哌卡因阻滞治疗,观察对其治疗总有效率、患者的依从满意度,以评价此项治疗方法的效果。并在置管、阻滞前后监测患者心率(HR)、收缩压(SBP)、舒张压(DBP)、平均动脉压(MBP)变化的平均值变化,记录置管后有无脱管、感染及药物不良反应等并发症,以评估此项操作技术的安全性。方法:通过选择2013年10月~2015年1月到邢台市第三医院住院治疗的突发性单耳耳聋患者126例,按照随机分组原则,将病例分为置管阻滞组、阻滞组、对照组各42例,三组给予常规综合治疗:活血药物、糖皮质激素和高压氧综合治疗,置管阻滞组应用星状神经节穿刺后留置导管,间断0.1%罗哌卡因10ml阻滞1次/日;阻滞组1次/日星状神经节穿刺并罗哌卡因阻滞;对照组只应用基础综合治疗。置管阻滞组和阻滞组先进行阻滞治疗,再行高压氧舱治疗。观察三组治疗总有效率,采用满意度评价表测评患者满意度,观察置管阻滞组和阻滞组第1疗程首次阻滞和第2~7次阻滞前、5min后心率(HR)、收缩压(SBP)、舒张压(DBP)、平均动脉压(MBP)的变化,记录置管后有无脱管、感染及药物不良反应等并发症,以评估此治疗方法的安全性。结果:置管阻滞组与阻滞组总有效率比较,两组无统计学意义{85.7%(37例)比83.3%(35例),P0.05},此研究中置管阻滞组有效率多于阻滞组,置管阻滞组、阻滞组总有效率明显高于对照组〔85.7%(37例)、83.3%(35例)比64.3%(27例),P0.05〕,置管阻滞组患者满意率明显高于阻滞组〔83.3%(35例)比61.9%(26例),P0.05〕。置管阻滞组与阻滞组首次置管前、5min后心率、血压的均变化明显,〔心率(次/min):72.0±7.7比94.5±8.3;73.0±7.7比93.0±7.9,收缩压(mm Hg,1 mm Hg=0.133 k Pa):122.2±12.6比136.8±18.1;123.6±11.0比134.6±20.8,平均动脉压(mm Hg):96.3±17.6比109.3±25.6;95.4±15.6比110.5±24.6,舒张压(mm Hg):80.3±21.2比94.7±23.8;78.5±20.9比95.1±25.6,均P0.05〕,两组间比较无差异。第2~7次阻滞前、5min后置管阻滞组心率、血压变化不明显(P0.05),而阻滞组变化明显〔心率(次/min):73.0±8.7比95.0±9.7,收缩压(mm Hg,1 mm Hg=0.133 k Pa):123.7±14.0比138.6±21.5,平均动脉压(mm Hg):96.2±17.6比112.7±25.1,舒张压(mm Hg):78.7±19.9比96.3±23.5,均P0.05〕;无药物不良反应和脱管、感染等不良事件发生,说明此治疗方法是安全的。结论:1突发性耳聋患者在活血、激素、高压氧等综合治疗基础上,配合应用0.1%罗哌卡因星状神经节间断阻滞,达到各治疗措施协同作用,提高了治疗总有效率。2应用0.1%罗哌卡因星状神经节间断阻滞时,给予星状神经节置管保留,减少因反复穿刺对患者的痛苦和不适感,降低穿刺时对机体血流动力学方面的影响,提高了患者的满意度和舒适度,体现了以人为本的服务理念。3星状神经节穿刺阻滞过程中对机体血流动力学方面的影响较大,而置管保留后再次治疗时对机体血流动力学方面的影响较小,治疗中未发生脱管、感染、药物不良反应等意外事件,说明此治疗方法是安全可行的,可以作为突发性耳聋的综合治疗方法之一,值得临床同仁借鉴。
[Abstract]:Objective: To observe the total effective rate of Shuxuening injection, ligustrazine, vitamin B12 and glucocorticoid combined with hyperbaric oxygen therapy, stellate ganglion catheterization and intermittent application of 0.1% ropivacaine blockade in patients with sudden deafness. To evaluate the efficacy of this procedure and to assess the safety of this technique by monitoring the mean changes of heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MBP) before and after catheterization and blockade, and recording the complications of catheterization, infection and adverse drug reactions. From January 2015 to January 2015 in Xingtai Third Hospital, 126 patients with sudden deafness were divided into catheter block group, block group and control group according to the principle of random grouping. Three groups were given routine comprehensive treatment: blood-activating drugs, glucocorticoid and hyperbaric oxygen therapy, and stellate ganglion puncture group. Indwelling catheter, intermittent 0.1% ropivacaine 10 ml block 1 time / day; block group 1 time / stellate ganglion puncture and ropivacaine block; control group only use basic comprehensive treatment. catheter block group and block group first block treatment, then hyperbaric oxygen chamber treatment. observe the total effective rate of three groups of treatment, using satisfaction evaluation table to evaluate patients satisfaction The changes of heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MBP) were observed 5 minutes before the first course of treatment and 2-7 times of treatment in the catheter block group and the block group. The complications such as catheterization, infection and adverse drug reactions were recorded to evaluate the safety of the treatment. There was no significant difference in the total effective rate between the two groups {85.7% (37 cases) vs 83.3% (35 cases), P 0.05}. In this study, the effective rate of catheter block group was higher than that of block group. The total effective rate of catheter block group was significantly higher than that of control group [85.7% (37 cases), 83.3% (35 cases) vs 64.3% (27 cases), P 0.05] and the satisfaction rate of catheter block group was significantly higher than that of block group [83.7% (37 cases), P 0.05]. 3% (35 cases) were 61.9% (26 cases) and 61.9% (35 cases) were 61.9% (26 cases) before and 5 minutes after the first catheterization, the changes of heart rate, blood pressure and heart rate were significant before and 5 minutes after the first catheterization in both the catheter block group and the block group, [heart rate (sub/min): 72.0 [(sub/min): 72.0 [(sub/min): 72.7.7.7.7.7.7.7 vs 94.5 [.7.7.7.7.7.7.3; 73.0 [(73.0 [7.7.7.7.7.7.7.7.7.7) vs 93.0.0.0.0.0 [.0.7.9 [.9 g: 96.3 +17. There was no significant difference in heart rate and blood pressure between the two groups before and 5 minutes after catheterization (P 0.05). G, 1 mm Hg = 0.133 K Pa: 123.7 (+ 14.0) vs 138.6 (+ 21.5), mean arterial pressure (mm Hg): 96.2 (+ 17.6) vs 112.7 (+ 25.1), diastolic blood pressure (mm Hg): 78.7 (+ 19.9) vs 96.3 (+ 23.5), all P 0.05); no adverse drug reactions, decannulation, infection and other adverse events occurred, indicating that this treatment is safe. On the basis of comprehensive treatment, combined with the application of 0.1% ropivacaine stellate ganglion intermittent block, to achieve the synergistic effect of various treatment measures, improve the total effective rate of treatment. 3. Stellate ganglion puncture blockade has a greater impact on hemodynamics of the body, but it has less impact on hemodynamics of the body when the catheter is retained and treated again. The treatment is safe and feasible, and can be used as one of the comprehensive treatment methods for sudden deafness. It is worth using for reference by clinical colleagues.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R614
[Abstract]:Objective: To observe the total effective rate of Shuxuening injection, ligustrazine, vitamin B12 and glucocorticoid combined with hyperbaric oxygen therapy, stellate ganglion catheterization and intermittent application of 0.1% ropivacaine blockade in patients with sudden deafness. To evaluate the efficacy of this procedure and to assess the safety of this technique by monitoring the mean changes of heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MBP) before and after catheterization and blockade, and recording the complications of catheterization, infection and adverse drug reactions. From January 2015 to January 2015 in Xingtai Third Hospital, 126 patients with sudden deafness were divided into catheter block group, block group and control group according to the principle of random grouping. Three groups were given routine comprehensive treatment: blood-activating drugs, glucocorticoid and hyperbaric oxygen therapy, and stellate ganglion puncture group. Indwelling catheter, intermittent 0.1% ropivacaine 10 ml block 1 time / day; block group 1 time / stellate ganglion puncture and ropivacaine block; control group only use basic comprehensive treatment. catheter block group and block group first block treatment, then hyperbaric oxygen chamber treatment. observe the total effective rate of three groups of treatment, using satisfaction evaluation table to evaluate patients satisfaction The changes of heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MBP) were observed 5 minutes before the first course of treatment and 2-7 times of treatment in the catheter block group and the block group. The complications such as catheterization, infection and adverse drug reactions were recorded to evaluate the safety of the treatment. There was no significant difference in the total effective rate between the two groups {85.7% (37 cases) vs 83.3% (35 cases), P 0.05}. In this study, the effective rate of catheter block group was higher than that of block group. The total effective rate of catheter block group was significantly higher than that of control group [85.7% (37 cases), 83.3% (35 cases) vs 64.3% (27 cases), P 0.05] and the satisfaction rate of catheter block group was significantly higher than that of block group [83.7% (37 cases), P 0.05]. 3% (35 cases) were 61.9% (26 cases) and 61.9% (35 cases) were 61.9% (26 cases) before and 5 minutes after the first catheterization, the changes of heart rate, blood pressure and heart rate were significant before and 5 minutes after the first catheterization in both the catheter block group and the block group, [heart rate (sub/min): 72.0 [(sub/min): 72.0 [(sub/min): 72.7.7.7.7.7.7.7 vs 94.5 [.7.7.7.7.7.7.3; 73.0 [(73.0 [7.7.7.7.7.7.7.7.7.7) vs 93.0.0.0.0.0 [.0.7.9 [.9 g: 96.3 +17. There was no significant difference in heart rate and blood pressure between the two groups before and 5 minutes after catheterization (P 0.05). G, 1 mm Hg = 0.133 K Pa: 123.7 (+ 14.0) vs 138.6 (+ 21.5), mean arterial pressure (mm Hg): 96.2 (+ 17.6) vs 112.7 (+ 25.1), diastolic blood pressure (mm Hg): 78.7 (+ 19.9) vs 96.3 (+ 23.5), all P 0.05); no adverse drug reactions, decannulation, infection and other adverse events occurred, indicating that this treatment is safe. On the basis of comprehensive treatment, combined with the application of 0.1% ropivacaine stellate ganglion intermittent block, to achieve the synergistic effect of various treatment measures, improve the total effective rate of treatment. 3. Stellate ganglion puncture blockade has a greater impact on hemodynamics of the body, but it has less impact on hemodynamics of the body when the catheter is retained and treated again. The treatment is safe and feasible, and can be used as one of the comprehensive treatment methods for sudden deafness. It is worth using for reference by clinical colleagues.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R614
【参考文献】
相关期刊论文 前9条
1 董少梅;赵书佑;;利多卡因星状神经节阻滞辅助治疗突发性耳聋的效果[J];齐鲁医学杂志;2009年06期
2 陈永权;金孝\，
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