高压氧治疗对顺铂性耳聋疗效的回顾性分析

发布时间：2018-01-31 00:11

本文关键词： 高压氧治疗顺铂性耳聋听力疗效　出处：《吉林大学》2017年硕士论文　论文类型：学位论文

【摘要】：背景:近年来,随着肿瘤发病率的逐年上升,抗肿瘤的代表性药物顺铂(Cisplatin,DDP)在临床的应用也越来越普遍,随之而来其带来的毒副作用也引起人们的高度重视。因为顺铂是以浓度决定疗效的抗肿瘤药物,所以短时间内给药的浓度越高,疗效就会越好;而肾脏毒性和耳毒性则限制了顺铂的大剂量使用,因此会影响疗效。顺铂的肾脏毒性,通过水化疗法、利尿剂和肾保护剂的应用可以得到明显缓解,然而对于其耳毒性,目前除中断治疗外,尚无明确有效的防护及治疗措施。因此最让广大临床工作者头疼的是顺铂的耳毒性,轻则听力减退,重则全聋,而且往往是不可逆的。高压氧治疗是指把患者置于高于一个大气压的氧舱内,吸入高于0.1MPa的高浓度氧气来达到治疗疾病作用的一种新型的治疗方法,且近年来高压氧治疗已经被广泛应用于临床,其优点在于可迅速改善内耳的缺氧及微循环、对抗氧化应激损伤、减轻内耳水肿,在突发性耳聋、噪音性耳聋及药物性耳聋等相关耳源性疾病以及其他疾病中体现了较好的疗效。目的:通过观察和探讨高压氧治疗对顺铂性耳聋的疗效,为治疗顺铂性耳聋提供可靠的临床依据。方法:通过回顾性分析我院收治的42例顺铂性耳聋患者的临床资料,并分为治疗组(高压氧联合药物治疗)24例和对照组(单纯药物治疗)18例,通过监测纯音测听及声阻抗,来监测患者听力变化。分析两组患者的临床资料特点,比较两组患者的预后及影响因素,采用SPSS17.0进行统计学分析,比较计数资料的率、构成比,用交叉表卡方检验,检验水准为α=0.05,所有的检验均为双效检验,(P0.05为具有统计学意义)。结果:1.单纯药物治疗组:治愈率14.8%,有效率70.4%,无效率29.6%。药物联合高压氧治疗组:治愈率35.1%,有效率94.6%,无效率5.4%。经X~2检验P=0.033,P0.05,两组间的差异具有统计学意义。2.药物联合高压氧治疗组,在不同听力损伤程度耳聋患者疗效不同,轻、中度组:总体有效率100.0%;重度、全聋组:总体有效率81.8%,无效率18.2%。经X~2检验P=0.025,P0.05,两组间的差异具有统计学意义。结论:1.顺铂性耳聋的发病率在性别上没有明显差异,多为双耳发生,常伴有耳鸣、眩晕等,听力下降以中重度多见,听力曲线以高频损失型多见。2.在条件许可的情况下,药物联合高压氧治疗组的患者治愈率(35.1%)和有效率(94.6%)均大于单纯药物组(14.8%,70.4%)。3.在治疗时间上,就诊越早效果越好,随着时间推移治疗有效性会降低。4.听力损失程度可影响高压氧治疗的疗效。
[Abstract]:Background: in recent years, as the tumor incidence increased year by year, the representative of antitumor drug cisplatin (Cisplatin, DDP) is more and more widely used in clinical, toxic and side effects of the attendant also attracted people's attention. Because the antitumor effect of drug cisplatin is determined by concentration, so a short period of time the concentrations in the administration of the higher, the better effect; and nephrotoxicity and ototoxicity is limited by the use of high dose cisplatin, it will affect the efficacy. The renal toxicity of cisplatin, through hydration therapy, diuretics and renal protective agent can significantly alleviate, but for its ototoxicity, in addition to the current interruption of treatment. There is no clear and effective protection and treatment measures. Therefore most let the majority of clinicians is a headache for cisplatin ototoxicity, mild hearing loss, while total deafness, and is often irreversible. Hyperbaric oxygen therapy refers to the patient At higher than an atmospheric oxygen, a new therapy method to achieve the effect of disease treatment inhalation of high concentration of oxygen is higher than 0.1MPa, and in recent years, hyperbaric oxygen therapy has been widely used in clinical application, the utility model has the advantages of rapid improvement of hypoxia and inner ear microcirculation, against oxidative stress damage, reduce the inner ear edema in sudden deafness, noise deafness and drug deafness related ear diseases and other diseases shows good effect. Objective: To observe and explore the efficacy of hyperbaric oxygen therapy on cisplatin induced deafness, provide reliable clinical basis for the treatment of cisplatin induced deafness. Methods: a retrospective study the clinical data of 42 cases with deafness patients in our hospital, and divided into treatment group (hyperbaric oxygen combined drug therapy) 24 cases and control group (drug treatment) in 18 cases, by monitoring the pure tone audiometry and sound The impedance to monitor the hearing of the patients with clinical data. Analysis of characteristics of the two groups of patients, the prognosis factors were compared between the two groups and the effect was statistically analyzed by SPSS17.0, comparing the count data rate, constituent ratio, cross table chi square test, inspection standards for a =0.05, all of the tests were double test (P0.05 is statistically significant). Results: 1. drug treatment group: the cure rate was 14.8%, efficiency was 70.4%, no efficiency of 29.6%. drugs combined with hyperbaric oxygen in the treatment group, the cure rate was 35.1%, efficiency 94.6%, invalid rate of 5.4%. testing by X~2 P= 0.033, P0.05, the difference between the two groups was statistically significant.2. drugs combined with high pressure oxygen therapy group, in different degree of hearing loss of deaf patients curative effect, light, moderate group: the total efficiency of 100%; severe deaf group: the total effective rate was 81.8%, no efficiency of 18.2%. by X~2 test P=0.025, P0.05, and the difference between the two groups with the Statistically significant. Conclusion: the incidence of 1. cisplatin deafness rate has no obvious difference in sex, for both ears, often accompanied by dizziness, tinnitus, hearing loss in severe hearing curve to see more, see more.2. type high-frequency loss under the conditions permit, with drugs combined with hyperbaric oxygen therapy group the cure rate (35.1%) and efficiency (94.6%) was higher than the simple drug group (14.8%, 70.4%).3. in the treatment of treatment time, the sooner the better, with the passage of time the effectiveness of treatment will reduce the degree of hearing loss can affect the efficacy of.4. hyperbaric oxygen therapy.

【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R764.43

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