【摘要】：目的:此研究是針對突發(fā)性單耳耳聾患者在給予舒血寧注射液、川芎嗪、維生素B12、糖皮質(zhì)激素治療的基礎(chǔ)上,聯(lián)合高壓氧治療,配合應(yīng)用星狀神經(jīng)節(jié)置管保留,并間斷應(yīng)用0.1%羅哌卡因阻滯治療,觀察對其治療總有效率、患者的依從滿意度,以評價此項治療方法的效果。并在置管、阻滯前后監(jiān)測患者心率(HR)、收縮壓(SBP)、舒張壓(DBP)、平均動脈壓(MBP)變化的平均值變化,記錄置管后有無脫管、感染及藥物不良反應(yīng)等并發(fā)癥,以評估此項操作技術(shù)的安全性。方法:通過選擇2013年10月~2015年1月到邢臺市第三醫(yī)院住院治療的突發(fā)性單耳耳聾患者126例,按照隨機(jī)分組原則,將病例分為置管阻滯組、阻滯組、對照組各42例,三組給予常規(guī)綜合治療:活血藥物、糖皮質(zhì)激素和高壓氧綜合治療,置管阻滯組應(yīng)用星狀神經(jīng)節(jié)穿刺后留置導(dǎo)管,間斷0.1%羅哌卡因10ml阻滯1次/日;阻滯組1次/日星狀神經(jīng)節(jié)穿刺并羅哌卡因阻滯;對照組只應(yīng)用基礎(chǔ)綜合治療。置管阻滯組和阻滯組先進(jìn)行阻滯治療,再行高壓氧艙治療。觀察三組治療總有效率,采用滿意度評價表測評患者滿意度,觀察置管阻滯組和阻滯組第1療程首次阻滯和第2~7次阻滯前、5min后心率(HR)、收縮壓(SBP)、舒張壓(DBP)、平均動脈壓(MBP)的變化,記錄置管后有無脫管、感染及藥物不良反應(yīng)等并發(fā)癥,以評估此治療方法的安全性。結(jié)果:置管阻滯組與阻滯組總有效率比較,兩組無統(tǒng)計學(xué)意義{85.7%(37例)比83.3%(35例),P0.05},此研究中置管阻滯組有效率多于阻滯組,置管阻滯組、阻滯組總有效率明顯高于對照組〔85.7%(37例)、83.3%(35例)比64.3%(27例),P0.05〕,置管阻滯組患者滿意率明顯高于阻滯組〔83.3%(35例)比61.9%(26例),P0.05〕。置管阻滯組與阻滯組首次置管前、5min后心率、血壓的均變化明顯,〔心率(次/min):72.0±7.7比94.5±8.3;73.0±7.7比93.0±7.9,收縮壓(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,平均動脈壓(mm Hg):96.3±17.6比109.3±25.6;95.4±15.6比110.5±24.6,舒張壓(mm Hg):80.3±21.2比94.7±23.8;78.5±20.9比95.1±25.6,均P0.05〕,兩組間比較無差異。第2~7次阻滯前、5min后置管阻滯組心率、血壓變化不明顯(P0.05),而阻滯組變化明顯〔心率(次/min):73.0±8.7比95.0±9.7,收縮壓(mm Hg,1 mm Hg=0.133 k Pa):123.7±14.0比138.6±21.5,平均動脈壓(mm Hg):96.2±17.6比112.7±25.1,舒張壓(mm Hg):78.7±19.9比96.3±23.5,均P0.05〕;無藥物不良反應(yīng)和脫管、感染等不良事件發(fā)生,說明此治療方法是安全的。結(jié)論:1突發(fā)性耳聾患者在活血、激素、高壓氧等綜合治療基礎(chǔ)上,配合應(yīng)用0.1%羅哌卡因星狀神經(jīng)節(jié)間斷阻滯,達(dá)到各治療措施協(xié)同作用,提高了治療總有效率。2應(yīng)用0.1%羅哌卡因星狀神經(jīng)節(jié)間斷阻滯時,給予星狀神經(jīng)節(jié)置管保留,減少因反復(fù)穿刺對患者的痛苦和不適感,降低穿刺時對機(jī)體血流動力學(xué)方面的影響,提高了患者的滿意度和舒適度,體現(xiàn)了以人為本的服務(wù)理念。3星狀神經(jīng)節(jié)穿刺阻滯過程中對機(jī)體血流動力學(xué)方面的影響較大,而置管保留后再次治療時對機(jī)體血流動力學(xué)方面的影響較小,治療中未發(fā)生脫管、感染、藥物不良反應(yīng)等意外事件,說明此治療方法是安全可行的,可以作為突發(fā)性耳聾的綜合治療方法之一,值得臨床同仁借鑒。
[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.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R614

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相關(guān)期刊論文 前9條

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本文編號：2176526