【摘要】：背景 特發(fā)性聾(ISHL),國內(nèi)也稱突發(fā)性聾(SHL),相當(dāng)于美國的“特發(fā)性突發(fā)感音神經(jīng)性聾”(ISSNHL),發(fā)病率逐年上升并呈現(xiàn)年輕化趨勢(shì)。“難治性”ISHL是經(jīng)初始治療失敗的ISHL,具有中重度、病程較長(zhǎng)、療效差、合并特殊疾病治療手段局限等特點(diǎn)。 ISHL的診治面臨“爭(zhēng)議”的現(xiàn)狀：發(fā)病機(jī)制不清,多學(xué)科研究熱點(diǎn)；臨床界治療方案?jìng)?cè)重點(diǎn)不同,療效差別大；國內(nèi)外指南對(duì)定義標(biāo)準(zhǔn)、輔助檢查、治療方法、療效標(biāo)準(zhǔn)、預(yù)后和隨訪闡述不一；高壓氧(HBO)治療方案亟需完善。 “難治性”ISHL是ISHL的特殊類型,目前概念模糊,缺乏科學(xué)系統(tǒng)的闡述；近年來流行病學(xué)特點(diǎn)呈現(xiàn)新的變化：逐漸成為一種以耳部癥狀為主,嚴(yán)重影響生活質(zhì)量的全身性疾病。 海軍總醫(yī)院全軍高壓氧治療中心近年來收治的ISHL患者越來越多,前來就診的多是外院治療療效差,或錯(cuò)過最佳治療時(shí)間窗,或重度聽力損害,或合并特殊疾病的“難治性”ISHL。觀察發(fā)現(xiàn)：該類“難治性”ISHL患者多有明顯的情緒問題或緊迫的生活環(huán)境,發(fā)病后極其煩惱；臨床界對(duì)該病的認(rèn)識(shí)程度和治療方法不一,療效差異大,存在諸多分歧。為此開展并設(shè)計(jì)本研究。 目的 通過半隨機(jī)、部分雙盲、臨床對(duì)照試驗(yàn)研究,探討：(1)“難治性”ISHL臨床新特點(diǎn)；(2)“難治性”ISHL與應(yīng)激的關(guān)系、可能的一元化病因機(jī)制學(xué)說及量化的應(yīng)激評(píng)估指標(biāo)；(3)糖皮質(zhì)激素聯(lián)合HBO綜合治療“難治性”ISHL的療效；(4)不同吸氧方式對(duì)“難治性”ISHL療效的影響；(5)合并特殊疾病人群“難治性”ISHL的個(gè)體化治療方案。旨在為臨床再認(rèn)識(shí)該類疾病、提高治療效果作一參考。 對(duì)象與方法 1.研究對(duì)象 挑選海軍總醫(yī)院全軍高壓氧治療中心2012.02-2013.12病房收治的53例、2012.01-2014.02病房收治的67例、2012.01-2014.02門診及病房收治的79例、2011.02-2014.01門診及病房收治的101例、2012.02-2014.01收治的6例合并特殊疾病(4例合并慢性腎功能不全、2例合并白血病)及1例小兒ISHL患者。 2.納入標(biāo)準(zhǔn) ①符合中華醫(yī)學(xué)會(huì)耳鼻咽喉頭頸外學(xué)科分會(huì)制定的SHL診斷標(biāo)準(zhǔn)；②均為單耳發(fā)病,未經(jīng)糖皮質(zhì)激素靜脈或足療程治療；③符合“難治性”ISHL條件,納入研究時(shí)病程14d；④頭顱或顳骨(內(nèi)聽道)影像學(xué)檢查未見異常；⑤無糖皮質(zhì)激素全身治療及高低壓氧治療絕對(duì)禁忌癥；⑥否認(rèn)心律失常、甲狀腺機(jī)能亢進(jìn)或減退、2型糖尿病、貧血病史。 3.研究方法 3.1“難治性”ISHL臨床特點(diǎn)分析 所有患者入院48h內(nèi)：采用自制量表收集發(fā)病時(shí)基本資料,匹茲堡睡眠質(zhì)量問卷(PSQI)評(píng)估睡眠質(zhì)量,90項(xiàng)癥狀量表(SCL-90)測(cè)評(píng)心理健康狀態(tài)。SCL-90測(cè)評(píng)結(jié)果與中國正常人常模(N=1388)對(duì)比分析；于海軍總醫(yī)院耳鼻喉科隔音屏蔽室內(nèi)完成純音測(cè)聽、鼓室聲阻抗檢查。收集數(shù)據(jù)進(jìn)行流行病學(xué)分析。 3.2“難治性”ISHL發(fā)病機(jī)制探討 所有患者均于入院48h內(nèi)、治療開始前完成應(yīng)激(壓力)反應(yīng)問卷(SRQ)、純音測(cè)聽、心率變異率(HRV)、甲功三項(xiàng)(T3、T4、TSH)檢查或化驗(yàn)。應(yīng)激狀態(tài)評(píng)估借助應(yīng)激(壓力)反應(yīng)問卷測(cè)評(píng)；心率變異率(HRV)借助“FLY-2型神經(jīng)生理信息工作站”,采用短程(5min)測(cè)定方法采集并分析。 所有患者采取統(tǒng)一“應(yīng)激改善”治療方案。治療第14d復(fù)查純音測(cè)聽,并依據(jù)聽力療效分為“無效組”、“治療有效果組(包含有效、顯效、治愈)”。回顧性分析兩組治療前檢查、化驗(yàn)指標(biāo)差異,并結(jié)合文獻(xiàn)解讀。 3.3糖皮質(zhì)激素聯(lián)合HBO治療“難治性”ISHL臨床研究 參考患者意愿,依據(jù)隨機(jī)分配原則,將入選患者分為：HBO聯(lián)合糖皮質(zhì)激素治療組44例,單純HBO組35例。另外在我院同期耳鼻喉科收治的ISHL患者,選取使用糖皮質(zhì)激素但未進(jìn)行HBO治療患者32例,作為單純糖皮質(zhì)激素治療組。 治療前后進(jìn)行純音測(cè)聽檢測(cè);聽力改善率=(治療前聽力-治療后的聽力)／(治療前聽力-未受影響的對(duì)側(cè)耳的聽力)×100%。比較三組治療效果。 3.4不同吸氧方式綜合治療“難治性”ISHL臨床研究 101例患者,隨機(jī)分為A、B、C三組,A組37例,B組37例,C組27例。在統(tǒng)一治療方案的基礎(chǔ)上：A組聯(lián)合0.20MPa HBO治療,B組聯(lián)合0.16MPa HBO治療,C組聯(lián)合0.10MPa(常壓)面罩吸純氧治療,1次/d,療程14d。A、B組治療期間出現(xiàn)耳悶加重,查鼓室聲阻抗“C型曲線”患者9例,調(diào)整為0.07MPa(海拔3000米大氣壓)吸純氧治療3-5次,納入D組。A組剩余患者納為A1組(34例),B組剩余患者納為B1組(31例)。所有患者分別于治療前、第14d查純音測(cè)聽和鼓室聲阻抗。比較四組治療療效。 3.5合并特殊疾病人群“難治性”ISHL HBO綜合治療臨床研究 觀察、分析7例(4例合并慢性腎功能不全、2例合并白血病、1例小兒)患者病例資料,總結(jié)診療、護(hù)理體會(huì),結(jié)合文獻(xiàn)復(fù)習(xí)。 4.治療方法 所有患者均給予地塞米松磷酸鈉注射液(10mg,莫非氏管入,1/d,連續(xù)5-7d；5mg,莫非氏管入,1/d,連續(xù)5-7d)、銀杏葉提取物注射液(20m1,靜脈滴注,1/d,共10～14d)、天麻素注射液(0.6g,靜脈滴注,1/d,共10～14d),甲鈷胺片口服(500ug,3/日),靜脈輸液同時(shí)行HBO(1/d,每周治療5d,共10～20次)或常壓面罩吸純氧治療。根據(jù)病情輔以改善睡眠藥物、抗焦慮抑郁類藥物、科普宣教及心理疏導(dǎo)。 5.統(tǒng)計(jì)學(xué)處理 采用SPSS13.0軟件進(jìn)行統(tǒng)計(jì)學(xué)處理,計(jì)量資料以均數(shù)±標(biāo)準(zhǔn)差(x±s)表示,組間比較采用t檢驗(yàn)；三種療法的治愈率和有效率采用卡方檢驗(yàn),有效率比較采用秩和檢驗(yàn)；平均聽閾差值比較采用方差分析。以P0.05為差異顯著。 結(jié)果 1.“難治性”ISHL臨床特點(diǎn)分析 “難治性”ISHL好發(fā)于夏季(43.4%),女性占64.2%,大學(xué)、大專、碩士學(xué)歷人群占84.9%,腦力勞動(dòng)者占75.5%,A型血占47.2%,O型血占30.2%,反復(fù)突聾發(fā)作人群占35.8%；發(fā)病前常見誘發(fā)因素為：睡眠差、勞累、發(fā)脾氣、熬夜、飲酒、噪音接觸；合并基礎(chǔ)疾病中,高脂血癥(41.5%)比例最大；60.4%患者存在睡眠差,PSQI8.5±2.6分；軀體化、強(qiáng)迫、抑郁、焦慮、敵對(duì)、精神病性因子分值較常模比較有統(tǒng)計(jì)學(xué)差異(P0.05)。 2.“難治性”ISHL發(fā)病機(jī)制探討 治療總有效率79.1%。兩組SRQ差異有統(tǒng)計(jì)學(xué)意義(P0.05),兩組分值均高于常模。HRV中,有效果組HF、LF、LF/HF三項(xiàng)指標(biāo)值均高于無效組,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。無效組中,LF、LF/HF兩項(xiàng)指標(biāo)均數(shù)都低于正常范圍下限值；有效果組中,LF均數(shù)明顯高于正常范圍上限值。兩組T3、TSH的濃度有統(tǒng)計(jì)學(xué)差異(P0.05)。T3濃度,有效果組高于無效組；TSH濃度,無效組高于有效果組。 3.糖皮質(zhì)激素聯(lián)合HBO治療“難治性”ISHL臨床研究 治療過程中,因血壓和血糖控制不理想未能堅(jiān)持糖皮質(zhì)激素治療1例,因中耳調(diào)壓不良自行中斷HBO治療4例。最后,有效果44例(41.5%),治愈17例(16%)。與單純糖皮質(zhì)激素組和單純HBO組比較,HBO聯(lián)合糖皮質(zhì)激素組的有效率(59.52%)明顯高于其它兩組,治愈率三組間無顯著差異(P0.05),HBO聯(lián)合糖皮質(zhì)激素組的聽力改善率(61.3±4.7%)顯著高于其它兩組(P0.05)。 4.不同吸氧方式綜合治療“難治性”ISHL臨床研究 總有效率比較,A1、B1、C三組有統(tǒng)計(jì)學(xué)差異(X2=6.218,P0.05),A1、B1、D三組差異無統(tǒng)計(jì)學(xué)意義(X2=0.876,P0.05)；治療前后PTA提高值比較,A1、B1組均高于C組(F=3.63,P0.05；A1與C組比較Dunneet-t=2.34, P0.05；B1與C組比較Dunnett-t=3.01, P0.005)。 D組患者治療14d后鼓室聲阻抗均為A型曲線,耳悶堵感癥狀減輕優(yōu)于A1、B1組。 5.合并特殊疾病人群“難治性”ISHL HBO綜合治療臨床研究 “難治性”ISHL合并腎功能不全人群,多為“全聾型”感音神經(jīng)性聽力損害；治療中主要采用“糖皮質(zhì)激素”治療,特別是鼓室內(nèi)給藥途徑,輔以維生素、中藥湯劑、HBO治療；患者情緒的控制和睡眠改善是應(yīng)激緩解、治療配合和療效提高的重點(diǎn)；血液透析雖然沒有被證實(shí)有效,但血液透析可以保證患者腎功能對(duì)治療藥物的安全耐受性；促紅細(xì)胞生成素、葉酸、鐵劑對(duì)貧血的改善影響可能起到一定的促進(jìn)聽力恢復(fù)作用。 “難治性”ISHL合并白血病患者療效差。沒有進(jìn)行足療程、有效的抗病毒治療,或許是療效差的部分原因；白血病患者長(zhǎng)期使用免疫抑制劑或糖皮質(zhì)激素,易引起糖皮質(zhì)激素受體親和力下降或糖皮質(zhì)激素抵抗,減低抗炎效價(jià),故常規(guī)劑量和療程的糖皮質(zhì)激素可能抗炎治療效果差；反復(fù)波動(dòng)的貧血缺氧、粒細(xì)胞增減或凝血功能變化,可引起內(nèi)耳經(jīng)常性的應(yīng)激刺激,造成內(nèi)耳細(xì)胞持續(xù)性的水腫反應(yīng)和炎性損害；HBO治療受粒細(xì)胞水平、貧血程度及感染性發(fā)熱等影響,難以足療程實(shí)施；白血病患者使用藥物廣、并發(fā)癥多,易并存焦慮等神經(jīng)癥癥狀,治療難度大,依從性較差。 小兒“難治性”ISHL多發(fā)現(xiàn)較晚、聽力損害程度重。病毒感染可能是其主要病因,聽覺多頻穩(wěn)態(tài)誘發(fā)電位(MFSSR)是其重要的聽力學(xué)檢查。即使發(fā)病2月以上,短效糖皮質(zhì)激素仍可作為選用藥物,且使用療程宜偏長(zhǎng)；可間斷加用低壓力HBO治療,療程10-20次。佩戴大功率助聽器或行外科干預(yù)前,一切有利于聽力恢復(fù)的內(nèi)科綜合治療均應(yīng)積極應(yīng)用,特別是糖皮質(zhì)激素和低壓力HBO治療的應(yīng)用,以期盡可能的提高或恢復(fù)患兒聽力。護(hù)理中,護(hù)士應(yīng)針對(duì)小兒“難治性”ISHL特點(diǎn)加強(qiáng)患兒父母的科普宣教,注重小兒、家長(zhǎng)雙重心理護(hù)理,囑治療期間避免激惹和噪音刺激,鼓勵(lì)家長(zhǎng)多與患兒溝通,以正性引導(dǎo)、物質(zhì)激勵(lì)為主。 結(jié)論 1、“難治性”ISHL夏季高發(fā),好發(fā)于更年期女性、高學(xué)歷、腦力勞動(dòng)者、A型和0型血、反復(fù)突聾發(fā)作人群,睡眠質(zhì)量差、心理情緒異常較明顯,應(yīng)激障礙(負(fù)性生活事件、情緒波動(dòng)、疲勞、失眠等單因素或諸因素聯(lián)合作用)可能是其發(fā)病機(jī)制之一。 2、應(yīng)激障礙可能是“難治性”ISHL發(fā)病的誘發(fā)因素,或是發(fā)病后繼發(fā)其他損傷的加重因素。HRV結(jié)果可作為糖皮質(zhì)激素治療“難治性”ISHL敏感性及療效預(yù)測(cè)的指標(biāo)之一,T3和TSH變化可反應(yīng)ISHL的機(jī)體應(yīng)激程度。 3、HBO聯(lián)合糖皮質(zhì)激素對(duì)“難治性”ISHL較單純療法效果好,在實(shí)施HBO聯(lián)合治療的過程中需要對(duì)糖皮質(zhì)激素的不良反應(yīng)加以監(jiān)控。 4、高壓氧聯(lián)合地塞米松磷酸鈉注射液、銀杏葉提取物注射液是治療“難治性”ISHL的有效方法。0.16MPa高壓氧治療,療效滿意,經(jīng)濟(jì)成本低,更具優(yōu)勢(shì)；耳悶堵感癥狀明顯時(shí)可調(diào)整為0.07MPa低壓艙吸氧治療。 5、針對(duì)不同的“難治性”ISHL人群,在追求最大療效同時(shí),宜采取個(gè)體化原則,盡可能的避免基礎(chǔ)疾病加重和減少并發(fā)癥。
[Abstract]:background
Idiopathic deafness (ISHL), also known as sudden deafness (SHL) in China, is equivalent to "idiopathic sudden sensorineural hearing loss" (ISSNHL) in the United States. The incidence of onset is rising year by year and showing a trend of youth. "Refractory" ISHL is a ISHL with a failure of initial treatment. It has the characteristics of moderate to severe, long course, poor curative effect and limited treatment of special diseases.
The diagnosis and treatment of ISHL is faced with the status of "dispute": the pathogenesis is not clear, the multidisciplinary research hot spot; the clinical community treatment scheme is different and the curative effect is different; the domestic and foreign guidelines are not one of the definition standard, the auxiliary examination, the treatment method, the curative effect standard, the prognosis and the follow-up, and the hyperbaric oxygen (HBO) treatment plan needs to be perfected urgently.
"Refractory" ISHL is a special type of ISHL. At present, the concept is vague and lack of scientific system. In recent years, the characteristics of epidemiology have shown new changes: gradually become a kind of systemic disease which mainly affects the quality of life with the ear symptoms.
In recent years, there are more and more ISHL patients admitted to the whole army hyperbaric oxygen therapy center in Navy General Hospital. Most of the patients who come to the hospital have poor treatment effect, or miss the best time window, or severe hearing impairment, or the "refractory" ISHL. with special diseases: the "refractory" ISHL patients have obvious emotional problems or more obvious emotional problems. The urgent living environment is extremely annoying after the onset of the disease; the degree of understanding and treatment of the disease in the clinical community is different, the curative effect is different and there are many differences. Therefore, the study is carried out and designed.
objective
A semi randomized, partially blind, clinically controlled trial study was conducted to explore: (1) the new clinical characteristics of "refractory" ISHL; (2) the relationship between refractory ISHL and stress, the possible monetized etiological mechanism and quantitative stress evaluation index; (3) the effect of glucocorticoid combined with HBO in the treatment of "refractory" ISHL; (4) different oxygen inhalation The effect of the "refractory" ISHL on the therapeutic effect of "refractory" and (5) the individualized treatment scheme of "refractory" ISHL in the group with special diseases was designed to provide a reference for the clinical recognition of the disease and the improvement of the therapeutic effect.
Object and method
1. research objects
53 cases of 2012.02-2013.12 in Navy General Hospital, 67 cases in 2012.01-2014.02 ward, 79 cases in 2012.01-2014.02 out-patient and ward, 101 cases in 2011.02-2014.01 outpatient and ward, 6 cases with special diseases treated with 2012.02-2014.01 (4 cases with chronic renal insufficiency, 2 cases) And leukaemia) and 1 cases of ISHL in children.
2. inclusion criteria
(1) the SHL diagnostic criteria were established in accordance with the Chinese Medical Association of Otolaryngology and the head and neck branch; both were single ear, without glucocorticoid vein or foot treatment; (3) conformed to the "refractory" ISHL condition and included the course of the study in the course of 14d; (4) the skull or temporal bone (internal auditory) imaging examination was not abnormal; 5 Absolute contraindication of body therapy and hyperbaric oxygen therapy; _Denialof arrhythmia, hyperthyroidism or hypoxia, type 2 diabetes mellitus, anemia history.
3. research methods
Analysis of clinical characteristics of 3.1 "refractory" ISHL
All patients were admitted to 48h: using the self-made scale to collect the basic data of the disease, the Pittsburgh sleep quality questionnaire (PSQI) was used to evaluate the quality of sleep. The 90 symptom checklist (SCL-90) was used to evaluate the psychological health status.SCL-90 results and the Chinese normal norm (N=1388), and the pure sound shielding room of Navy General Hospital was pure. Audiometry, tympanic acoustic impedance test, data collection and epidemiological analysis.
Study on the pathogenesis of 3.2 "refractory" ISHL
All patients were hospitalized in 48h. Before the treatment, stress (stress) response questionnaire (SRQ), pure tone audiometry, heart rate variability (HRV), three items of thyroid function (T3, T4, TSH) were examined or tested. Stress state assessment was assessed with stress (stress) response questionnaire, and heart rate variability (HRV) using "FLY-2 neurophysiological information workstation" and short range (5m). In) the determination method was collected and analyzed.
All patients were treated with unified "stress improvement" treatment. The treatment of 14d was reviewed by the treatment of pure tone audiometry, and the results were divided into "invalid group" according to the hearing effect. "The treatment group (including effective, effective, cure)". Retrospective analysis of two groups before treatment, the difference of test indexes, and the literature interpretation.
3.3 glucocorticoid combined with HBO in the treatment of refractory ISHL
According to the wishes of the patients, according to the principle of random distribution, the selected patients were divided into 44 cases of HBO combined with glucocorticoid treatment group and 35 cases in group HBO alone. In addition, 32 cases of ISHL patients who were treated with glucocorticoids in the Department of ENT at the same period in our hospital were selected as simple glucocorticoid treatment group.
Pure tone audiometry before and after treatment, hearing improvement = (pre treatment hearing treatment hearing) / (pre treatment hearing - unaffected hearing of the side of the lateral ear) * * 100%. were compared in the three groups.
3.4 clinical study of different ways of oxygen inhalation in the treatment of refractory ISHL
101 patients were randomly divided into group A, B, C three, group A 37 cases, B group 37 cases and C group 27 cases. On the basis of unified treatment scheme, A group combined 0.20MPa HBO treatment, B group combined 0.16MPa HBO treatment, group joint (normal pressure) inhalation of pure oxygen therapy, 1 times of treatment, course of treatment, ear aggravation during the treatment, and the sound impedance of tympanum. 9 cases were adjusted to 0.07MPa (altitude of 3000 m) for 3-5 times of pure oxygen therapy. The remaining patients in group.A of group D were included in group A1 (34 cases), and the remaining patients in group B were included in group B1 (31 cases). All patients were treated with pure tone audiometry and tympanic acoustic impedance before treatment, and the treatment effect was compared between the four groups.
3.5 clinical study of refractory ISHL HBO combined treatment for patients with special diseases
Observation and analysis of 7 cases (4 cases with chronic renal insufficiency, 2 cases with leukemia, 1 case of children) case data, summarize the diagnosis and treatment, nursing experience, combined with literature review.
4. treatment methods
All patients were given Dexamethasone Sodium Phosphate Injection (10mg, 1/d, continuous 5-7d; 5mg, 5mg, 1/d, continuous 5-7d), Extract of Ginkgo Biloba Leaves Injection (20m1, intravenous drip, 1/d, 10 to 14d), Gastrodin Injection (0.6g, intravenous drip, 1/d, altogether 10 ~ 14d), Mecobalamin Tablets orally (1/d, 10~20 times a week for 5D, a total of 10~20) or normal pressure mask for pure oxygen therapy. According to the condition, the sleep drugs, antidepressants, science popularization and psychological counseling are improved.
5. statistical treatment
The SPSS13.0 software was used for statistical processing, and the measurement data were expressed with mean standard deviation (x + s), and t test was used among groups. The cure rate and efficiency of the three treatments were checked by chi square test, the efficiency was compared with the rank sum test, and the average hearing threshold difference was compared with the variance analysis. The difference was significant with P0.05.
Result
Analysis of clinical characteristics of 1. "refractory" ISHL
"Refractory" ISHL occurred in summer (43.4%), women accounted for 64.2%, University, college, master degree population accounted for 84.9%, mental workers accounted for 75.5%, A type of blood accounted for 47.2%, O type of blood accounted for 30.2%, and recurrent sudden deafness seizures accounted for 35.8%. The common inducing factors before the onset were sleep poor, tired and angry, staying up late, drinking, noise exposure, combined with basic diseases. The proportion of hyperlipidemia (41.5%) was the largest, and 60.4% patients had poor sleep and PSQI8.5 2.6. The scores of somatization, compulsion, depression, anxiety, hostility and psychotic factors were statistically different compared with those of normal models (P0.05).
Study on the pathogenesis of 2. "refractory" ISHL
The total effective efficiency of the treatment of 79.1%. two groups SRQ difference was statistically significant (P0.05), the two groups were higher than the normal model.HRV, the effect group HF, LF, LF/HF three index values were higher than the invalid group, the difference was statistically significant (P0.05). In the invalid group, LF, LF/HF two indexes are lower than the normal range; LF average in the effective group is obviously higher than the number The concentration of T3 and TSH in the effective group was higher than that in the ineffective group; the concentration of TSH in the ineffective group was higher than that in the effective group.
3. glucocorticoid combined with HBO in the treatment of refractory ISHL
In the course of treatment, 1 cases were failed to adhere to glucocorticoid treatment because of poor blood pressure and blood sugar control. 4 cases were treated by self interruption of HBO because of poor middle ear pressure. Finally, there were 44 cases (41.5%) and 17 cases (16%). Compared with the simple glucocorticoid group and the simple HBO group, the effective rate of HBO combined glucocorticoid group (59.52%) was significantly higher than the other two. There was no significant difference in the cure rate among the three groups (P 0.05). The improvement rate of hearing in HBO combined with glucocorticoid group was significantly higher than that in the other two groups (P 0.05).
4. clinical study of different ways of oxygen inhalation in the treatment of refractory ISHL
There were statistical differences between the three groups of A1, B1 and C (X2=6.218, P0.05), A1, B1, and D three groups had no statistical significance (X2=0.876, P0.05). The acoustic impedance was all A curve, and the symptoms of ear congestion were relieved better than those of group A1 and group B1.
5. clinical study of refractory ISHL HBO combined treatment for patients with special diseases
"Refractory" ISHL combined with renal dysfunction, mostly "fully deaf" sensorineural hearing impairment; the treatment mainly used "glucocorticoid" treatment, especially in the tympanum, supplemented by vitamin, decoction of Chinese medicine, HBO treatment; emotional control and sleep improvement of patients are stress relief, treatment coordination and effective improvement Although hemodialysis is not proved to be effective, hemodialysis can guarantee the safety tolerance of the patient's renal function to the treatment of drugs; the effect of erythropoietin, folic acid, and iron on anemia may play a certain role in promoting hearing recovery.
"Refractory" ISHL combined with leukemia patients have poor curative effect. No foot therapy, effective antiviral therapy, may be part of the cause of poor curative effect; long term use of immunosuppressive agents or glucocorticoids in leukemia patients may cause the decline of glucocorticoid receptor affinity or glucocorticoid resistance to reduce the anti inflammatory potency, so the routine dose The curative effect of the glucocorticoid and the course of glucocorticoid may be poor. Repeated anaemia, anoxia, granulocyte increase or change of blood clotting function can cause frequent stress stimulation of the inner ear, resulting in the persistent edema and inflammatory damage of the inner ear cells; the effect of HBO on the level of granulocyte, the degree of anemia and infectious fever is difficult to foot. Leukemia patients use a wide range of drugs, complications, anxiety and other neurological symptoms, treatment difficulty, poor compliance.
The "refractory" ISHL in children is found late and the degree of hearing damage is heavy. The virus infection may be the main cause of the disease. The auditory multi frequency steady-state evoked potential (MFSSR) is an important audiological examination. Even if the onset of the disease is above February, the short effect glucocorticoid can still be used as a drug, and the course should be longer, and the low pressure HBO can be used intermittently. 10-20 times of treatment. Before wearing high power hearing aids or surgical intervention, all comprehensive medical treatment for hearing recovery should be actively applied, especially the application of glucocorticoid and low stress HBO treatment in order to improve or restore children's hearing as much as possible. In nursing, nurses should strengthen children's "refractory" ISHL characteristics. Parents' popularization of science and education, pay attention to children, parents double psychological nursing, to avoid irritation and noise stimulation during the treatment, encourage parents to communicate with children, with positive guidance, material incentives.
conclusion
1, "refractory" ISHL high incidence in summer, good hair in menopause women, high education, mental workers, A and type 0 blood, recurrent sudden deafness attacks, poor sleep quality, psychological and emotional abnormalities, stress disorder (negative life events, emotional fluctuations, fatigue, insomnia and other factors or factors combined) may be one of the mechanisms of the disease.
2, stress
【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R764.43

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 余力生;;突發(fā)性聾治療概述[J];中國耳鼻咽喉頭頸外科;2010年10期

2 錢迪;楊瓊;彭麗華;高春生;高進(jìn)良;陳君明;;深圳市突發(fā)性聾患者的生活質(zhì)量及心理狀況調(diào)查[J];中國醫(yī)藥科學(xué);2013年12期

3 任基浩,劉斌,盧永德;兒童突發(fā)性感音神經(jīng)性聾發(fā)病特點(diǎn)分析[J];臨床耳鼻咽喉科雜志;2004年01期

4 劉凌;李森;朱曉梅;曹佩江;顧慶;;心率變異性和應(yīng)激激素基礎(chǔ)水平在評(píng)價(jià)運(yùn)動(dòng)致應(yīng)激中的價(jià)值[J];臨床心血管病雜志;2011年12期

5 祝筱姬;趙超;張定益;張春梅;任婧婧;郭思潤;;飛行訓(xùn)練對(duì)戰(zhàn)斗機(jī)飛行員甲狀腺激素影響的研究[J];航空航天醫(yī)學(xué)雜志;2011年10期

6 蔣源;張菊芳;王瑋;黑燕;;以突發(fā)性聾為首發(fā)癥狀的慢性粒細(xì)胞白血病1例[J];臨床耳鼻咽喉科雜志;2006年10期

7 呂麗;江虹;李文杰;陳翠;張紅靜;;突發(fā)性耳聾患者的情緒特征及應(yīng)對(duì)方式[J];山東大學(xué)學(xué)報(bào)(醫(yī)學(xué)版);2011年07期

8 林楓,吳宏,虞幼軍;少兒突發(fā)性耳聾33例臨床分析[J];實(shí)用醫(yī)學(xué)雜志;2001年08期

9 楊華;陳曉巍;高志強(qiáng);王劍;;前列地爾治療難治性突發(fā)性聾臨床研究[J];聽力學(xué)及言語疾病雜志;2009年03期

10 張姝;高晶;李玲香;;突發(fā)性聾發(fā)病機(jī)制的研究進(jìn)展[J];聽力學(xué)及言語疾病雜志;2012年01期

，

本文編號(hào)：2169834