激光鼓膜打孔鼓室内应用甲泼尼龙琥珀酸钠滴入及高压氧治疗“不良预后”突发性耳聋的临床对比研究

发布时间：2018-05-15 19:26

本文选题：听觉丧失 + 突发性　；参考：《川北医学院》2015年硕士论文

【摘要】：目的:对比研究经激光鼓膜穿孔鼓室内应用甲泼尼龙琥珀酸钠滴入及高压氧治疗“不良预后”突发性耳聋的疗效差异。方法:将2012年12月至2014年12月住院的经治疗7天无效且符合纳入及排除标准的突发性聋患者60例,随机分为鼓室内激素治疗组(实验组)和高压氧组(对照组)。实验组给予激光鼓膜打孔、鼓室内激素滴入,对照组给予高压氧治疗,两组均同时运用改善微循环、营养神经药物。所有患者均住院治疗。对两组病例治疗前的匹配性、治疗后10天及1月听力改善、疗效进行统计分析。P0.05为差异具有统计学意义。结果:1.鼓室内激素治疗组(实验组)和高压氧组(对照组)间平均年龄、性别比、单纯耳鸣患者比例、耳鸣伴眩晕患者比例、治疗前听力、患耳左右侧间差异均无统计学意义(P0.05)。2.鼓室内激素治疗组(实验组)治疗前平均听阈(Pure tone average,PTA)为84.6±20.7 d B,治疗10天后PTA为62.8±27.4 d B,改善21.9±24.3d B,治疗前后PTA差异有统计学意义(t=3.49,P0.01)。高压氧组(对照组)治疗前PTA为76.9±22.3 d B,治疗10天后PTA为58.3±20.5 d B,P改善21.3±21.4 d B,治疗前后PTA差异有统计学意义(t=3.86,P0.01)。鼓室内激素治疗组(实验组)和高压氧组(对照组)组间听力改善差异无统计学意义(t=0.89,P0.05)。3.鼓室内激素治疗组(实验组)治疗前PTA为84.6±20.7 d B,治疗1月后PTA为54.2±26.7 d B,改善30.4±15.1 d B,治疗前后PTA差异有统计学意义(t=5.17,P0.01)。高压氧组(对照组)治疗前PTA为76.9±22.3d B,治疗1月后PTA为50.7±19.3 d B,改善28.9±17.5 d B,治疗前后PTA差异有统计学意义(t=5.38,P0.01)。鼓室内激素治疗组(实验组)和高压氧组(对照组)组间听力改善差异无统计学意义(t=0.35,P0.05)。4.鼓室内激素治疗组(实验组)和高压氧组(对照组)经治疗10天,有效率分别为53.3%、43.3%,组间差异无统计学意义(?2=0.6007,P0.05)。5.鼓室内激素治疗组(实验组)和高压氧组(对照组)经治疗1月,有效率分别为83.3%、76.7%,组间差异无统计学意义(?2=0.4167,P0.05)。结论:经激光鼓膜打孔鼓室内应用甲泼尼龙琥珀酸钠滴入及高压氧治疗“不良预后”突发性耳聋均有效,两者间短期及中期疗效无明显差异。可临床推广应用。
[Abstract]:Objective: to compare the therapeutic effects of methylprednisolone sodium succinate and hyperbaric oxygen in the treatment of sudden deafness after laser tympanic membrane perforation. Methods: sixty patients with sudden deafness who were hospitalized from December 2012 to December 2014 were randomly divided into two groups: the experimental group (experimental group) and the hyperbaric oxygen group (control group). The experimental group was treated with laser perforation of tympanic membrane, hormone was dripped into tympanic chamber, and the control group was treated with hyperbaric oxygen. Both groups were treated with improving microcirculation and nourishing nerve drugs at the same time. All patients were hospitalized. Two groups of cases before treatment matching, 10 days and 1 month after treatment hearing improvement, the effect of statistical analysis. P0.05 was statistically significant difference. The result is 1: 1. There was no significant difference in average age, sex ratio, simple tinnitus patients, tinnitus patients with vertigo, hearing before treatment, left and right side of the affected ears. The average hearing threshold before treatment was 84.6 卤20.7 dB in the experimental group and 62.8 卤27.4 dB after 10 days of treatment, and 21.9 卤24.3 dB was improved in the steroid treatment group (experimental group). The difference of PTA before and after treatment was statistically significant (P 0.01). In the hyperbaric oxygen group (control group), the PTA was 76.9 卤22.3 dB before treatment, and the PTA was 58.3 卤20.5d BNP after 10 days treatment. The difference of PTA before and after treatment was statistically significant (P < 0.01). There was no significant difference in hearing improvement between experimental group (experimental group) and hyperbaric oxygen group (control group). PTA was 84.6 卤20.7 dB before treatment and 54.2 卤26.7 dB after treatment in the intracympanic hormone treatment group (experimental group), and the improvement was 30.4 卤15.1 dB. The difference of PTA before and after treatment was statistically significant (P 0.01). In the hyperbaric oxygen group (control group), PTA was 76.9 卤22.3 dB before treatment, PTA was 50.7 卤19.3dB after treatment for one month, and the improvement was 28.9 卤17.5 dB. The difference of PTA before and after treatment was statistically significant (P 0.01). There was no significant difference in hearing improvement between experimental group (experimental group) and hyperbaric oxygen group (control group). After 10 days of treatment, the effective rates of hormone treatment group (experimental group) and hyperbaric oxygen group (control group) were 53.3 and 43.3, respectively. There was no significant difference between the two groups. The effective rates of steroid treatment group (experimental group) and hyperbaric oxygen group (control group) were 83.3% and 76.7% respectively. There was no significant difference between the two groups (P 0.05). Conclusion: intratympanic injection of methylprednisolone succinate sodium and hyperbaric oxygen are effective in the treatment of "poor prognosis" sudden deafness, but there is no significant difference between them in short and medium term. It can be popularized and applied in clinic.
【学位授予单位】：川北医学院
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R764.437

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