高压氧治疗中青年突发性耳聋疗效回顾性分析
发布时间：2019-02-18 11:49
【摘要】：目的:突发性耳聋(sudden deafness SD)是指突然发生的,原因不明的感音神经性听力损失。可发生在数分钟、数小时、3天或以内,可伴耳鸣、耳堵塞感、眩晕、恶心、呕吐等[1]。给病人带来很大的痛苦。虽经积极治疗,但仍有部分患者会遗留听力永久性损失、耳鸣等后遗症,成为严重危害健康的一种耳科疾病。Charrier等[2]研究表明,本病通常单耳受累。其病因复杂,很多致病因素可以导致。其中循环障碍学说、病毒感染学说、自身免疫学说得到较多认同。由上面一个或多个因素作用引起耳蜗组织结构和功能改变,从而出现听力下降是现在较为认可的病理机制。而目前普遍认为耳蜗循环功能障碍是突发性耳聋最主要的病因,因此,对于SD的治疗主要目的是改善内耳微循环,提高内耳血管及内外淋巴液的氧分压,防止耳蜗听细胞病变坏死,促进Na+ -K+离子泵的功能恢复和加速耳蜗电生理功能的修复。突聋属于耳鼻咽喉科急症,近年来发病有增加趋势,目前发病率大约为8～14.6/10万[3]。且趋于年轻化,其预后对于患者特别是中青年患者的生活质量有重大影响。而目前无特别有效的治疗方法,临床上主要采取扩血管、抗凝、改善微循环、抗病毒、激素及高压氧、鼓室内注药等综合治疗。而临床实践和动物实验[4]已经证实高压氧( hyperbaric oxygen,HBO)在治疗SD及其伴发症状上有着积极作用。本文回顾性分析了中青年突发性耳聋患者结合高压氧治疗的疗效。以探讨高压氧在治疗中青年突发性聋中的作用。 方法:对我院2009.1～2011.1收治的有详细病史资料的164例首次突发性耳聋患者进行回顾性分析,每位患者入院时均进行详细查体,完善病史,所有病例均参照中华医学会耳鼻咽喉头颈外科学分会和中华耳鼻咽喉头颈外科杂志编委会2005年在济南全国耳科会议上制定的突发性耳聋诊断标准[1]。全部患者均行电耳镜、纯音测听、声导抗,脑干诱发电位、颞骨CT、血常规、尿液检测序列、空腹血糖等检查,对有耵聍栓塞者取出耵聍后再行听力检查,同时排除中耳病变,听神经瘤等内听道占位性病变等相关疾病。并除外患有高血压、糖尿病、贫血等基础疾病患者。将患者治疗期间是否行高压氧治疗分为单纯药物治疗组和结合高压氧治疗组两组,并证实两组患者在年龄、性别、就诊时间、耳聋程度、耳聋类型、伴发症状(眩晕、耳鸣)、治疗时间上等分布均衡,无显著性差异,具有可比性。并经X2检验对两组的疗效(即痊愈率、显效率、有效率、无效率)进行评估。 结果:结合高压氧治疗患者的痊愈率18.8%和有效率70.0%均大于单纯性药物治疗的患者13.3%和59.5%。 结论:在药物基础上结合高压氧治疗突聋可以明显提高疗效。中青年突发性耳聋发病率高,遗留永久性听力下降等机会大,更应及早采取高压氧结合疗法进行治疗。
[Abstract]:Objective: sudden deafness (sudden deafness SD) is a sudden and unexplained loss of sensorineural hearing. May occur in a few minutes, hours, 3 days or less, can be accompanied by tinnitus, ear clogging, vertigo, nausea, vomiting, etc. [1] Bring great pain to the patient. Although after active treatment, some patients still have permanent hearing loss, tinnitus and other sequelae, and become a serious health hazards of ear disease. Charrier et al. [2] Research shows that this disease usually involves one ear. Its etiology is complex, many pathogenic factors can cause. Among them circulatory disorder theory, virus infection theory, self-immunity theory get more approval. Cochlear tissue structure and function are changed by one or more of the above factors, and hearing loss is now accepted as a pathological mechanism. At present, it is generally believed that the main cause of sudden deafness is the dysfunction of cochlear circulation. Therefore, the main purpose of SD treatment is to improve the inner ear microcirculation and increase the oxygen partial pressure of blood vessels and lymphatic fluid in the inner ear. To prevent the pathological necrosis of cochlear auditory cells, to promote the functional recovery of Na-K ion pump and to accelerate the repair of electrophysiological function of cochlea. Sudden deafness is an emergency in the department of otorhinolaryngology. The incidence of sudden deafness is increasing in recent years. The prognosis has a great influence on the quality of life of the patients, especially the young and middle-aged patients. At present, there are no effective treatment methods, such as vasodilation, anticoagulation, microcirculation improvement, antivirus, hormone and hyperbaric oxygen, intratympanic injection and so on. Clinical practice and animal experiments [4] have shown that hyperbaric oxygen (hyperbaric oxygen,HBO) plays an active role in the treatment of SD and its associated symptoms. The effect of hyperbaric oxygen therapy in young and middle-aged patients with sudden deafness was analyzed retrospectively. To explore the role of hyperbaric oxygen in the treatment of sudden deafness in young and middle-aged people. Methods: 164 patients with first sudden deafness admitted in our hospital from January 2001 to January 2011.1 were analyzed retrospectively. All cases were based on the diagnostic criteria for sudden deafness developed by the Chinese Medical Association Otorhinolaryngology head and neck surgery Society and the editorial Committee of the Chinese Journal of Otolaryngology and head and neck surgery in 2005 at the Jinan National Otiology Conference [1]. All patients were examined by electrootoscopy, pure tone audiometry, acoustic conductance, brainstem evoked potential, CT, blood routine of temporal bone, urine test sequence, fasting blood glucose, etc. Acoustic neuroma and other internal auditory space-occupying lesions and other related diseases. With the exception of hypertension, diabetes, anemia and other basic diseases. The patients were divided into two groups: drug therapy group and hyperbaric oxygen treatment group. It was confirmed that the patients in both groups were treated with age, sex, time of treatment, degree of deafness, type of deafness, accompanied symptoms (vertigo, tinnitus). There was no significant difference in the treatment time, and there was no significant difference between the two groups. X 2 test was used to evaluate the curative effect of the two groups (cure rate, effective rate and ineffective rate). Results: the cure rate and effective rate of patients treated with hyperbaric oxygen were 18.8% and 70.0%, respectively, which were higher than those of patients treated with simple drugs (13.3% and 59.5%). Conclusion: treatment of sudden deafness with hyperbaric oxygen on the basis of drugs can obviously improve the curative effect. The incidence of sudden deafness and the chance of permanent hearing loss in young and middle-aged patients are high, so it is necessary to adopt hyperbaric oxygen combined therapy as soon as possible.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R764
本文编号：2425802
[Abstract]:Objective: sudden deafness (sudden deafness SD) is a sudden and unexplained loss of sensorineural hearing. May occur in a few minutes, hours, 3 days or less, can be accompanied by tinnitus, ear clogging, vertigo, nausea, vomiting, etc. [1] Bring great pain to the patient. Although after active treatment, some patients still have permanent hearing loss, tinnitus and other sequelae, and become a serious health hazards of ear disease. Charrier et al. [2] Research shows that this disease usually involves one ear. Its etiology is complex, many pathogenic factors can cause. Among them circulatory disorder theory, virus infection theory, self-immunity theory get more approval. Cochlear tissue structure and function are changed by one or more of the above factors, and hearing loss is now accepted as a pathological mechanism. At present, it is generally believed that the main cause of sudden deafness is the dysfunction of cochlear circulation. Therefore, the main purpose of SD treatment is to improve the inner ear microcirculation and increase the oxygen partial pressure of blood vessels and lymphatic fluid in the inner ear. To prevent the pathological necrosis of cochlear auditory cells, to promote the functional recovery of Na-K ion pump and to accelerate the repair of electrophysiological function of cochlea. Sudden deafness is an emergency in the department of otorhinolaryngology. The incidence of sudden deafness is increasing in recent years. The prognosis has a great influence on the quality of life of the patients, especially the young and middle-aged patients. At present, there are no effective treatment methods, such as vasodilation, anticoagulation, microcirculation improvement, antivirus, hormone and hyperbaric oxygen, intratympanic injection and so on. Clinical practice and animal experiments [4] have shown that hyperbaric oxygen (hyperbaric oxygen,HBO) plays an active role in the treatment of SD and its associated symptoms. The effect of hyperbaric oxygen therapy in young and middle-aged patients with sudden deafness was analyzed retrospectively. To explore the role of hyperbaric oxygen in the treatment of sudden deafness in young and middle-aged people. Methods: 164 patients with first sudden deafness admitted in our hospital from January 2001 to January 2011.1 were analyzed retrospectively. All cases were based on the diagnostic criteria for sudden deafness developed by the Chinese Medical Association Otorhinolaryngology head and neck surgery Society and the editorial Committee of the Chinese Journal of Otolaryngology and head and neck surgery in 2005 at the Jinan National Otiology Conference [1]. All patients were examined by electrootoscopy, pure tone audiometry, acoustic conductance, brainstem evoked potential, CT, blood routine of temporal bone, urine test sequence, fasting blood glucose, etc. Acoustic neuroma and other internal auditory space-occupying lesions and other related diseases. With the exception of hypertension, diabetes, anemia and other basic diseases. The patients were divided into two groups: drug therapy group and hyperbaric oxygen treatment group. It was confirmed that the patients in both groups were treated with age, sex, time of treatment, degree of deafness, type of deafness, accompanied symptoms (vertigo, tinnitus). There was no significant difference in the treatment time, and there was no significant difference between the two groups. X 2 test was used to evaluate the curative effect of the two groups (cure rate, effective rate and ineffective rate). Results: the cure rate and effective rate of patients treated with hyperbaric oxygen were 18.8% and 70.0%, respectively, which were higher than those of patients treated with simple drugs (13.3% and 59.5%). Conclusion: treatment of sudden deafness with hyperbaric oxygen on the basis of drugs can obviously improve the curative effect. The incidence of sudden deafness and the chance of permanent hearing loss in young and middle-aged patients are high, so it is necessary to adopt hyperbaric oxygen combined therapy as soon as possible.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R764
【引证文献】
相关硕士学位论文 前2条
1 李保玺;针药结合治疗耳聋肝胆火盛型的临床研究[D];黑龙江中医药大学;2012年
2 王磊磊;电项针结合耳周穴针刺治疗突发性神经性耳聋的临床观察[D];黑龙江中医药大学;2013年
，本文编号：2425802
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