發(fā)布時(shí)間：2017-12-31 11:36

  本文關(guān)鍵詞：聲敏感的臨床特征及中醫(yī)病因病機(jī)研究　出處：《廣州中醫(yī)藥大學(xué)》2016年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 聲敏感 聽覺(jué)過(guò)敏 耳鳴 臨床特征 中醫(yī)病因病機(jī)

【摘要】：研究目的聲敏感指對(duì)正常聲音出現(xiàn)不適反應(yīng),是臨床上十分常見(jiàn)的病癥,與耳鳴的關(guān)系較為密切,近年來(lái)開始為醫(yī)學(xué)界所關(guān)注。目前國(guó)內(nèi)外對(duì)聲敏感這一現(xiàn)象無(wú)統(tǒng)一命名,亦缺乏流行病學(xué)研究資料,其病因、發(fā)病機(jī)制不清楚,臨床診斷及評(píng)估、治療均缺乏統(tǒng)一的認(rèn)識(shí)。有關(guān)聲敏感的中醫(yī)病因病機(jī)及治療的文獻(xiàn)研究極為罕見(jiàn)。本研究通過(guò)臨床流行病學(xué)調(diào)查,探討聲敏感的臨床特征、中醫(yī)病因病機(jī),從而為聲敏感的臨床診斷及評(píng)估、中醫(yī)藥治療及療效評(píng)價(jià)提供臨床資料。研究方法對(duì)2014年1月至2016年1月期間在廣州中醫(yī)藥大學(xué)第一附屬醫(yī)院耳鼻喉科門診及住院部以聲敏感或耳鳴為主訴的患者進(jìn)行臨床調(diào)查,在全面收集患者的基本資料(包括性別、年齡、職業(yè)、學(xué)歷、婚姻、民族等)的基礎(chǔ)上,主要從兩個(gè)方面進(jìn)行調(diào)查研究：第一是研究聲敏感的臨床特征,通過(guò)記錄患者聲敏感的具體臨床表現(xiàn)、伴隨癥狀、與耳鳴的關(guān)系,指導(dǎo)患者填寫“焦慮自評(píng)量表(SAS)”、“耳鳴情況調(diào)查表(包括TEQ)”、“聲敏感情況調(diào)查表(包括HQ)”,等,并隨機(jī)進(jìn)行聽力學(xué)檢查,試圖初步了解聲敏感的臨床特征；第二是研究聲敏感的中醫(yī)病因病機(jī),通過(guò)指導(dǎo)患者填寫“生活習(xí)慣調(diào)查表”、“全身健康狀況調(diào)查表”以了解患者的生活習(xí)慣及全身健康狀況,并從中醫(yī)辨證角度記錄患者的相關(guān)癥狀及舌象、脈象等信息,初步分析聲敏感的中醫(yī)病因病機(jī)。所有記錄的信息錄入Excel表格,用SPSS22.0軟件對(duì)所收集的相關(guān)數(shù)據(jù)進(jìn)行分析,計(jì)數(shù)資料運(yùn)用卡方檢驗(yàn),計(jì)量資料采用t檢驗(yàn)或方差分析。結(jié)果1.一般資料共收集符合納入標(biāo)準(zhǔn)的病例214例,男119例(55.61%),女95例(44.39%),平均年齡42.89+13.37歲。其中單純聲敏感者7例,聲敏感伴耳鳴98例,單純耳鳴而無(wú)聲敏感者109例,因單純聲敏感病例樣本量較少,故將前二者合并為一組稱為“聲敏感組”,共105例,男52例(49.52%),女53例(50.47%),平均年齡41.01±12.58歲。單純耳鳴組稱為“無(wú)聲敏感組”,共109例,男67例(61.47%),女42例(38.53%),平均年齡44.71±13.91歲。兩組性別無(wú)統(tǒng)計(jì)學(xué)差異(P0.05),年齡有統(tǒng)計(jì)學(xué)差異(P0.05)。2.臨床特征①聲敏感與耳鳴的關(guān)系：聲敏感組105例中,有耳鳴者98例,占93.3%,無(wú)耳鳴者7例,占6.7%。耳鳴207例中,有聲敏感者98例,占47.3%,無(wú)聲敏感者109例,占52.7%。依據(jù)TEQ評(píng)分來(lái)分級(jí)統(tǒng)計(jì)聲敏感的發(fā)生率,發(fā)現(xiàn)聲敏感發(fā)生率隨著耳鳴程度的加重而升高。在既有聲敏感又有耳鳴的98例患者中,耳鳴先于聲敏感發(fā)生者占34.7%,聲敏感先于耳鳴發(fā)生者占10.2%,同時(shí)發(fā)生者占55.1%。聲敏感的有無(wú)在耳鳴患者的發(fā)生與耳鳴主調(diào)聲頻率、殘余抑制試驗(yàn)結(jié)果、佛德曼曲線類型、主調(diào)聲類型等耳鳴心理聲學(xué)特征及純音測(cè)聽結(jié)果、耳聲發(fā)射檢查結(jié)果、SAS評(píng)分等差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。②常見(jiàn)的伴隨癥狀：聲敏感伴有聽力下降者占67.6%,伴有耳堵塞感者占58.1%,伴有眩暈反復(fù)發(fā)作史者占37.1%。③聲敏感的具體臨床表現(xiàn)：在105例聲敏感患者中對(duì)普通音量的聲音感到不適者占20%,對(duì)高于普通音量的聲音感到不適者占80%；61.9%對(duì)任何聲音均感到不適,38.1%對(duì)1種或多種特定聲音感到不適,常見(jiàn)的聲音有金屬敲擊聲、小孩哭鬧聲、女生講話聲、清嗓聲、汽車?yán)嚷暋⑼氲鲎猜暤�；常�?jiàn)的不適感有心煩、耳內(nèi)回響、耳內(nèi)刺痛、耳周麻木感、耳內(nèi)脹悶感、頭暈等；68.5%的患者外界聲音停止,不適感即消失,31.4%的患者外界聲音停止,不適感持續(xù)一段時(shí)間后消失；聲敏感組平均HQ評(píng)分為12.60±7.89,略高于健康人(P0.05)。3.中醫(yī)病因病機(jī)分析：聲敏感組中60%患有脾胃系疾病,92.4%壓力大,93.3%嗜食肥甘厚味,55.2%嗜食生冷寒涼食物,92.4%有睡眠障礙,與健康人進(jìn)行比較,P0.05,差異有統(tǒng)計(jì)學(xué)意義。聲敏感組患者脾胃功能平均積分為35.2±17.1,比健康人、無(wú)聲敏感組患者均升高。結(jié)論1.在耳鳴的患者中伴有聲敏感者占47.3%,在聲敏感的患者中伴有耳鳴者占93.3%,聲敏感很少單獨(dú)存在,多見(jiàn)于耳鳴患者中,且耳鳴越嚴(yán)重發(fā)生聲敏感的機(jī)率越高,在耳鳴的診治中應(yīng)充分關(guān)注是否合并聲敏感這一特殊現(xiàn)象。2.聲敏感的特征主要表現(xiàn)為對(duì)正常人可以接受的外界聲音感到心煩或產(chǎn)生耳內(nèi)回響、耳內(nèi)刺痛、耳周麻木感、耳內(nèi)脹悶感、頭暈等不適,約三分之二的患者在外界聲音停止后不適感可自動(dòng)消失,約三分之一的患者在外界聲音停止后不適感仍會(huì)持續(xù)一段時(shí)間才消失,常伴有耳鳴、聽力下降、耳堵塞感等癥狀,部分患者可伴有眩暈反復(fù)發(fā)作。如何合理評(píng)估聲敏感的嚴(yán)重程度,尚需進(jìn)一步研究。3.聲敏感與耳鳴具有相似的病因病機(jī),睡眠障礙、壓力大、不良的飲食習(xí)慣等導(dǎo)致脾胃功能失調(diào),可能是聲敏感及耳鳴發(fā)生的主要病因病機(jī)。
[Abstract]:The purpose of the study refers to the sound sensitive normal voice discomfort reaction, is the most common clinical symptoms are closely related to tinnitus, pay more attention to the medical profession at home and abroad in recent years. This phenomenon is not sensitive to the sound of uniform naming, also lack of epidemiological research material, its etiology and pathogenesis is unclear. The clinical diagnosis and treatment, assessment, lack of unified understanding. Literature research on etiology and pathogenesis of traditional Chinese medicine and the treatment of the sound sensitive is extremely rare. This study through the epidemiological investigation, clinical features of sound sensitive, TCM disease due to illness, thus for clinical diagnosis and evaluation of acoustic sensitivity, and provide clinical data evaluation of traditional Chinese medicine drug treatment and efficacy. Research methods from January 2014 to January 2016 in the First Affiliated Hospital of Guangzhou University of Chinese Medicine Department of ENT outpatient and inpatient department to sound sensitive or tinnitus patients into complaints Clinical investigation in patients with a comprehensive collection of basic information (including gender, age, occupation, education, marriage, nationality) on the basis of investigation and research, mainly from two aspects: the first is the study of the clinical features of sound sensitive, by recording the specific clinical manifestation, patients with acoustic sensitive symptoms and tinnitus the relationship, guide the patients to fill out the "self rating Anxiety Scale (SAS)", "tinnitus questionnaire (including TEQ)", "sound sensitive questionnaire (including HQ), etc., and random audiological examination, attempts to explore the clinical characteristics of acoustic sensitivity; second is to study the etiology and pathogenesis of acoustic sensitivity and through the guidance of patients to fill out the" lifestyle questionnaire "," general health questionnaire "to understand the living habits and general health status of the patients, and from the TCM perspective related symptoms were recorded and tongue, pulse and other information, 鍒濇鍒嗘瀽澹版晱鎰熺殑涓尰鐥呭洜鐥呮満.鎵，

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