發(fā)布時(shí)間：2018-04-22 13:29

  本文選題：鼓室內(nèi)灌注類(lèi)固醇激素 + 類(lèi)固醇激素��； 參考：《廣西醫(yī)科大學(xué)》2011年碩士論文

【摘要】：目的鼓室內(nèi)灌注類(lèi)固醇激素治療是目前可以用來(lái)替代全身系統(tǒng)性使用類(lèi)固醇激素治療特發(fā)性聾的一種較有前途的治療方法。然而,不同的研究之間的結(jié)果不同。本文的目的是對(duì)鼓室內(nèi)灌注類(lèi)固醇激素與不同治療方法治療特發(fā)性耳聾的療效分析。方法檢索Medline和Embase數(shù)據(jù)庫(kù),兩位分析員獨(dú)立評(píng)價(jià)文獻(xiàn)并提取數(shù)據(jù),采用Stata11.0軟件進(jìn)行Meta分析。結(jié)果通過(guò)檢索策略檢索出142篇文獻(xiàn),最后納入8個(gè)隨機(jī)對(duì)照試驗(yàn),其中4個(gè)試驗(yàn)納入的是首次治療特發(fā)性耳聾患者,4個(gè)試驗(yàn)納入的是經(jīng)全身系統(tǒng)性運(yùn)用類(lèi)固醇激素治療失敗后的患者。在首次治療的4個(gè)試驗(yàn)中有2個(gè)試驗(yàn)是鼓室內(nèi)灌注類(lèi)固醇激素與口服類(lèi)固醇激素的療效對(duì)比,1個(gè)試驗(yàn)是鼓室內(nèi)灌注、鼓室內(nèi)灌注加口服類(lèi)固醇激素與口服類(lèi)固醇激素三者的療效對(duì)比,而該試驗(yàn)按作兩個(gè)試驗(yàn)提取數(shù)據(jù),即鼓室內(nèi)灌注類(lèi)固醇激素對(duì)比口服類(lèi)固醇激素和鼓室內(nèi)灌注加口服類(lèi)固醇激素對(duì)比口服類(lèi)固醇激素,最后1個(gè)試驗(yàn)是鼓室內(nèi)灌注加口服類(lèi)固醇激素與口服類(lèi)固醇激素的療效對(duì)比。在鼓室內(nèi)灌注類(lèi)固醇激素與口服類(lèi)固醇激素首次治療療效對(duì)比的3個(gè)試驗(yàn)中,分析結(jié)果顯示前者稍?xún)?yōu)于后者,但無(wú)顯著性統(tǒng)計(jì)學(xué)差異(RR=1.22,95% CI 0.98至1.52,p=0.071)；在經(jīng)全身系統(tǒng)性使用類(lèi)固醇激素治療失敗后使用鼓室內(nèi)灌注類(lèi)固醇激素與對(duì)照組(有的為除激素外的其他常規(guī)治療對(duì)照,有的為安慰劑對(duì)照而有的以不再作進(jìn)一步的處理作為對(duì)照)的4個(gè)隨機(jī)對(duì)照試驗(yàn)的分析結(jié)果顯示,實(shí)驗(yàn)組明顯優(yōu)于對(duì)照組并且有顯著的統(tǒng)計(jì)學(xué)差異(RR=8.73,95% CI為2.46至30.92,p=0.001)。然而在2個(gè)對(duì)比鼓室內(nèi)灌注加口服類(lèi)固醇激素與口服類(lèi)固醇激素的療效的試驗(yàn)中,由于存在顯著的異質(zhì)性(χ2=4.45,p=0.035,12=77.5%),故未進(jìn)行Meta分析。此外,在全部8個(gè)試驗(yàn)中有243例接受了鼓室內(nèi)灌注處理,但只有2例發(fā)生了鼓膜穿孔,經(jīng)修補(bǔ)后均能治愈。結(jié)論對(duì)于不能耐受全身系統(tǒng)性使用類(lèi)固醇激素的患者,鼓室內(nèi)灌注類(lèi)固醇激素是一個(gè)很好的替代方法,即使是經(jīng)過(guò)全身系統(tǒng)性使用類(lèi)固醇激素失敗后的患者,鼓室內(nèi)灌注類(lèi)固醇激素仍是一個(gè)不錯(cuò)的挽救性治療方法,并且這一操作在臨床上是相對(duì)安全的。
[Abstract]:Objective Intratympanic steroid therapy is a promising alternative to systemic steroid hormone therapy for idiopathic deafness. However, the results vary from study to study. The purpose of this paper is to analyze the therapeutic effect of intratympanic infusion of steroid hormone and different treatment methods on idiopathic deafness. Methods Medline and Embase databases were searched. The two analysts independently evaluated the literature and extracted the data. Stata11.0 software was used for Meta analysis. Results 142 articles were retrieved by search strategy, and were included in 8 randomized controlled trials. Four of the trials involved the first treatment of idiopathic deafness and four included patients who had failed in systemic steroid therapy. Two of the first four trials were compared with oral steroid hormone infusion in the tympanic cavity, and one was in the tympanic cavity. The effects of intratympanic perfusion plus oral steroid hormone and oral steroid hormone were compared, and the data were extracted from two trials. That is, intratympanic infusion of steroid hormone versus oral steroid hormone and intratympanic perfusion plus oral steroid hormone versus oral steroid hormone, The final trial was a comparison of the effects of intratympanic perfusion with oral steroid hormones and oral steroid hormones. In three trials in which intratympanic steroids were infused with oral steroids for the first time, the results showed that the former was slightly better than the latter. However, there was no significant statistical difference between RRX 1.22 95% CI 0.98 to 1.52p0.071%, and after systemic steroid hormone therapy failed, intratympanic instillation of steroid hormone was given to the control group (some of which were compared with those of the control group). The results of four randomized controlled trials with placebo control and no further treatment showed that the experimental group was significantly superior to the control group and had a significant statistical difference between 2.46 and 30.92p0.001of RRN 8.7395% CI. However, Meta analysis was not carried out in two tests comparing the effects of intratympanic perfusion with oral steroid hormones and oral steroid hormones because of the significant heterogeneity (蠂 ~ 24.45). In addition, 243 cases were treated with intratympanic perfusion in all 8 trials, but only 2 cases had tympanic membrane perforation, all of which could be cured after repair. Conclusion Intratympanic instillation of steroid hormone is a good alternative for patients who cannot tolerate systemic steroid hormone use, even after systemic steroid use failure. Intratympanic steroid infusion is still a good rescue therapy, and this procedure is relatively safe clinically.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2011
【分類(lèi)號(hào)】：R764.43

【相似文獻(xiàn)】

相關(guān)期刊論文 前10條

1 胡景;鼓室內(nèi)灌注類(lèi)固醇治療突聾[J];國(guó)外醫(yī)學(xué).耳鼻咽喉科學(xué)分冊(cè);2002年06期

2 賈代杰;秦兆冰;盧偉;李素娟;陳曉華;;鼓室內(nèi)灌注地塞米松治療難治性突發(fā)性聾[J];臨床耳鼻咽喉頭頸外科雜志;2008年07期

3 李河清;孟祥明;文慶波;;地塞米松鼓室內(nèi)灌注治療突發(fā)性聾35例療效觀察[J];中國(guó)煤炭工業(yè)醫(yī)學(xué)雜志;2009年05期

4 黃桂球;傅敏儀;陳美珍;;鼓室內(nèi)灌注地塞米松作為重度、極重度突發(fā)性聾的補(bǔ)救治療[J];臨床醫(yī)學(xué)工程;2011年10期

5 刁玉佩;董明敏;;鼓室內(nèi)灌注地塞米松聯(lián)合藥物治療突發(fā)性聾90例療效分析[J];臨床耳鼻咽喉頭頸外科雜志;2012年07期

6 程欣;;鼓室內(nèi)灌注治療突發(fā)性耳聾的手術(shù)護(hù)理[J];江蘇醫(yī)藥;2010年05期

7 方文旭;蔡志福;廖智萍;;鼓室內(nèi)灌注得寶松和地塞米松治療突發(fā)性聾療效比較[J];中國(guó)中西醫(yī)結(jié)合耳鼻咽喉科雜志;2008年04期

8 彭好;張秋穎;周金梅;宋海濤;黃魏寧;;經(jīng)咽鼓管鼓室內(nèi)灌注地塞米松治療突發(fā)性聾[J];聽(tīng)力學(xué)及言語(yǔ)疾病雜志;2010年05期

9 劉冬梅;徐開(kāi)倫;;糖皮質(zhì)激素鼓室內(nèi)灌注治療突發(fā)性耳聾的研究進(jìn)展[J];醫(yī)學(xué)綜述;2012年10期

10 廖智萍;方文旭;蔡志福;;鼓室內(nèi)灌注類(lèi)固醇激素治療突發(fā)性耳聾的臨床研究[J];中外醫(yī)學(xué)研究;2013年36期

相關(guān)會(huì)議論文 前1條

1 秦兆冰;賈代杰;盧偉;李素娟;陳曉華;;鼓室內(nèi)灌注地塞米松治療難治性突發(fā)性聾臨床研究[A];中華醫(yī)學(xué)會(huì)第十次全國(guó)耳鼻咽喉-頭頸外科學(xué)術(shù)會(huì)議論文匯編（上）[C];2007年

相關(guān)碩士學(xué)位論文 前2條

1 戴善軍;鼓室內(nèi)灌注類(lèi)固醇激素治療特發(fā)性耳聾療效的Meta分析[D];廣西醫(yī)科大學(xué);2011年

2 高紅;不同途徑給藥后豚鼠外淋巴液中甲潑尼龍琥珀酸鈉的代謝動(dòng)力學(xué)特征[D];安徽醫(yī)科大學(xué);2012年

，

本文編號(hào)：1787409