耳后注射糖皮质激素治疗全频下降型突发性聋

发布时间：2018-05-24 17:07

  本文选题：突发性聋 + 糖皮质激素　； 参考：《遵义医学院》2017年硕士论文

【摘要】：目的:观察耳后注射糖皮质激素治疗全频下降型突发性聋的疗效,探讨耳后注射糖皮质激素在突发性聋的临床应用。方法:采用前瞻性对照研究,从2015年7月至2016年6月在深圳市龙岗区耳鼻咽喉医院收治的突发性聋病例中,选取符合纳入标准的全频下降型患者,按照入院顺序简单随机分为两组。66例患者纳入研究,其中男40例,女26例,左耳37例,右耳29例,年龄18-60岁,平均39岁,发病到开始治疗时间为1-14天,平均6天。耳后给药组(35例)给予耳后注射甲强龙,40 mg/d,连续5天;静脉给药组(31例)给予静脉滴注甲强龙,40 mg/d,连续5天;其他治疗方法两组相同。10天后比较两组疗效差异。应用SPSS 18.0软件进行统计学分析。结果:(1)听力损失:(1)总体比较:耳后给药组和静脉给药组的治疗有效率分别为71.42%(25/35)和77.41%(24/31),两组比较,差异无统计学意义(P0.05)。耳后给药组和静脉给药组治疗后的平均听阈分别为55.10±26.92 dB HL和41.12±23.56 dB HL,两组比较,差异有统计学意义(P0.05)。(2)单因素比较:将患者依次列入相同的听力损失程度组、年龄组、病程组和伴随症状组做平均听阈比较。结果显示:除了伴有眩晕症状组外,其他各因素组静脉给药对平均听阈的改善均优于耳后给药,其中听力损失程度为重度极重度组、病程为≤7天组,两种方法比较,差异有统计学意义(P0.05)。(2)耳鸣症状:90.91%(60/66)的患者有耳鸣,耳后给药组31例,静脉给药组29例,治疗有效率分别为77.41%(24/31)和75.86%(22/29),两组比较,差异无统计学意义(P0.05)。(3)眩晕症状:18.18%(12/66)的患者有眩晕,其中6例前庭功能正常,6例前庭功能异常,2例前庭功能异常合并有BPPV。静脉给药组6例,耳后给药组6例,均在治疗10天内眩晕症状得到控制。结论:(1)耳后注射糖皮质激素做为全频下降型突发性聋的初始治疗,对听力损失治疗有效,但听力提高幅度不如静脉给药明显;可改善耳鸣症状,但无明显作用优势;控制眩晕效果不明显。(2)对于无糖皮质激素全身给药禁忌症的全频下降型突发性聋患者,建议初始治疗仍选择静脉给药,尤其是听力损失程度为重度极重度聋或病程为≤7天的患者。
[Abstract]:Objective: to observe the effect of retroauricular glucocorticoid injection in the treatment of fully-frequency descending sudden deafness and to explore the clinical application of retroauricular glucocorticoid injection in sudden deafness. Methods: from July 2015 to June 2016 in Shenzhen Longgang District Otolaryngology Hospital, the patients with sudden deafness were selected from a prospective controlled study. According to the order of admission, the patients were randomly divided into two groups: 40 males, 26 females, 37 left ears, 29 right ears, aged 18-60 years, with an average age of 39 years. The mean time from onset to treatment was 1-14 days, with an average of 6 days. 35 patients in the retroauricular administration group were given 40 mg / d intraauricular injection of ketenolone 40 mg / d for 5 days, and 31 cases in the intravenous administration group were given 40 mg / d intravenous drip of 40 mg / d of ketoprolol for 5 days. The difference of curative effect between the two groups after 10 days was the same as that in the other two groups. SPSS 18.0 software was used for statistical analysis. Results the overall effective rates of retroauricular administration group and intravenous administration group were 71.42 / 35) and 77.41% / 31 respectively. There was no significant difference between the two groups (P 0.05). The average hearing threshold after treatment was 55.10 卤26.92 dB HL and 41.12 卤23.56 dB HL in the retroauricular group and intravenous group, respectively. The difference was statistically significant (P 0.05): the patients were divided into the same hearing loss group and age group in turn, and the average hearing threshold after treatment was 55.10 卤26.92 dB HL and 41.12 卤23.56 dB HL, respectively. The mean hearing threshold was compared between the course group and the concomitant symptom group. The results showed that the improvement of the average hearing threshold was better in the other factors group than in the retroauricular group except the group with vertigo symptoms. The degree of hearing loss was severe and the course of the disease was 鈮，

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