【摘要】：目的:突發(fā)性耳聾(sudden deafness SD)是指突然發(fā)生的,原因不明的感音神經(jīng)性聽力損失�？砂l(fā)生在數(shù)分鐘、數(shù)小時、3天或以內(nèi),可伴耳鳴、耳堵塞感、眩暈、惡心、嘔吐等[1]。給病人帶來很大的痛苦。雖經(jīng)積極治療,但仍有部分患者會遺留聽力永久性損失、耳鳴等后遺癥,成為嚴(yán)重危害健康的一種耳科疾病。Charrier等[2]研究表明,本病通常單耳受累。其病因復(fù)雜,很多致病因素可以導(dǎo)致。其中循環(huán)障礙學(xué)說、病毒感染學(xué)說、自身免疫學(xué)說得到較多認(rèn)同。由上面一個或多個因素作用引起耳蝸組織結(jié)構(gòu)和功能改變,從而出現(xiàn)聽力下降是現(xiàn)在較為認(rèn)可的病理機(jī)制。而目前普遍認(rèn)為耳蝸循環(huán)功能障礙是突發(fā)性耳聾最主要的病因,因此,對于SD的治療主要目的是改善內(nèi)耳微循環(huán),提高內(nèi)耳血管及內(nèi)外淋巴液的氧分壓,防止耳蝸聽細(xì)胞病變壞死,促進(jìn)Na+ -K+離子泵的功能恢復(fù)和加速耳蝸電生理功能的修復(fù)。突聾屬于耳鼻咽喉科急癥,近年來發(fā)病有增加趨勢,目前發(fā)病率大約為8～14.6/10萬[3]。且趨于年輕化,其預(yù)后對于患者特別是中青年患者的生活質(zhì)量有重大影響。而目前無特別有效的治療方法,臨床上主要采取擴(kuò)血管、抗凝、改善微循環(huán)、抗病毒、激素及高壓氧、鼓室內(nèi)注藥等綜合治療。而臨床實(shí)踐和動物實(shí)驗(yàn)[4]已經(jīng)證實(shí)高壓氧( hyperbaric oxygen,HBO)在治療SD及其伴發(fā)癥狀上有著積極作用。本文回顧性分析了中青年突發(fā)性耳聾患者結(jié)合高壓氧治療的療效。以探討高壓氧在治療中青年突發(fā)性聾中的作用。 方法:對我院2009.1～2011.1收治的有詳細(xì)病史資料的164例首次突發(fā)性耳聾患者進(jìn)行回顧性分析,每位患者入院時均進(jìn)行詳細(xì)查體,完善病史,所有病例均參照中華醫(yī)學(xué)會耳鼻咽喉頭頸外科學(xué)分會和中華耳鼻咽喉頭頸外科雜志編委會2005年在濟(jì)南全國耳科會議上制定的突發(fā)性耳聾診斷標(biāo)準(zhǔn)[1]。全部患者均行電耳鏡、純音測聽、聲導(dǎo)抗,腦干誘發(fā)電位、顳骨CT、血常規(guī)、尿液檢測序列、空腹血糖等檢查,對有耵聹栓塞者取出耵聹后再行聽力檢查,同時排除中耳病變,聽神經(jīng)瘤等內(nèi)聽道占位性病變等相關(guān)疾病。并除外患有高血壓、糖尿病、貧血等基礎(chǔ)疾病患者。將患者治療期間是否行高壓氧治療分為單純藥物治療組和結(jié)合高壓氧治療組兩組,并證實(shí)兩組患者在年齡、性別、就診時間、耳聾程度、耳聾類型、伴發(fā)癥狀(眩暈、耳鳴)、治療時間上等分布均衡,無顯著性差異,具有可比性。并經(jīng)X2檢驗(yàn)對兩組的療效(即痊愈率、顯效率、有效率、無效率)進(jìn)行評估。 結(jié)果:結(jié)合高壓氧治療患者的痊愈率18.8%和有效率70.0%均大于單純性藥物治療的患者13.3%和59.5%。 結(jié)論:在藥物基礎(chǔ)上結(jié)合高壓氧治療突聾可以明顯提高療效。中青年突發(fā)性耳聾發(fā)病率高,遺留永久性聽力下降等機(jī)會大,更應(yīng)及早采取高壓氧結(jié)合療法進(jìn)行治療。
[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.
【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】：2011
【分類號】：R764

【引證文獻(xiàn)】

相關(guān)碩士學(xué)位論文 前2條

1 李保璽;針?biāo)幗Y(jié)合治療耳聾肝膽火盛型的臨床研究[D];黑龍江中醫(yī)藥大學(xué);2012年

2 王磊磊;電項(xiàng)針結(jié)合耳周穴針刺治療突發(fā)性神經(jīng)性耳聾的臨床觀察[D];黑龍江中醫(yī)藥大學(xué);2013年

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本文編號：2425802