山东大学耳鼻喉眼学报 ›› 2019, Vol. 33 ›› Issue (4): 52-55.doi: 10.6040/j.issn.1673-3770.0.2018.408

• 论著 • 上一篇    下一篇

糖皮质激素不同给药方式治疗突发性聋的临床疗效及安全性研究

张俊军1,刘海莉2,刘加福2,秦小奉2,杜洪明1,王厚慧2   

  1. 1.莒县中医医院耳鼻喉科, 山东 莒县276599;
    2.莒县人民医院呼吸内科, 山东 莒县 276599
  • 出版日期:2019-07-20 发布日期:2019-07-22
  • 基金资助:
    山东省医药卫生科技发展计划项目(2017WSA11018)

Clinical efficacy and safety of different methods of administration of glucocorticoids in the treatment of sudden deafness

ZHANG Junjun1, LIU Haili2, LIU Jiafu2, QIN Xiaofeng2, DU Hongming1, WANG Houhui2   

  1. Department of Respiratory Medicine, Yixian People′s Hospital, Jixian County, Jvxian 276599, Shandong, China
  • Online:2019-07-20 Published:2019-07-22

摘要: 目的 观察糖皮质激素不同给药方式治疗突发性聋的临床疗效及安全性。 方法 将耳鼻喉科2017年1月至2018年3月收治的150例突发性聋患者按照住院顺序随机分为3组, 在应用改善微循环、营养神经药物治疗的基础上,鼓室穿刺组加用鼓室穿刺注射糖皮质激素,静脉滴注组加用静脉滴注糖皮质激素,耳后乳突组加用耳后乳突注射糖皮质激素。比较治疗后3组患者听力提高疗效及不良反应情况等。 结果 与治疗前相比,治疗2周后耳后注射糖皮质激素组疗效均优于静脉滴注糖皮质激素与鼓室穿刺注射糖皮质激素组,差异均有统计学意义(P<0.05)。3组不良反应及并发症比较,差异无统计学意义(P>0.05)。 结论 糖皮质激素耳后乳突区局部注射糖皮质激素治疗突发性聋的临床疗效更佳,不良反应发生率低,更安全可靠。

关键词: 突发性聋, 糖皮质激素, 耳后注射, 鼓膜穿刺, 临床疗效

Abstract: Objective The aim of the study was to investigate the clinical efficacy and safety of different methods of glucocorticoid administration in the treatment of sudden deafness. Methods One hundred and fifty patients with sudden deafness admitted in our hospital from January 2017 to March 2018 were randomly divided into three groups according to the hospitalization order. Based on the application of improved microcirculation methods, nutritional neuropharmacology, and tympanostomy, the groups were classified as tympanic glucocorticoid injection group, intravenous drip and intravenous infusion of glucocorticoid group, and postauricular mastoid group with postauricular mastoid injection of glucocorticoids. The improvement in hearing and adverse reactions of the three groups were compared after the completion of treatment. Results A comparison of the three groups before and after 2-weeks of hearing improvement treatment suggests that the effect of glucocorticoid injection in the postauricular mastoid region was better than intravenous infusion or tympanic injection of glucocorticoids, and the difference was observed to be statistically significant (P<0.05). However, no significant differences were observed in the rate of adverse reactions and complications among the three groups (P>0.05). Conclusion Glucocorticoid injection in the posterior mastoid area was found to be better for the treatment of sudden deafness. The incidence of adverse reactions is low, and, hence, the treatment can be deemed reliable and safe.

Key words: Sudden deafness, Corticosteroids, Postauricular injection, Tympanic membrane puncture, Clinical efficacy

中图分类号: 

  • R764.437
[1] 中华耳鼻咽喉头颈外科杂志编辑委员会, 中华医学会耳鼻咽喉头颈外科学分会. 突发性聋诊断和治疗指南(2015)[J]. 中华耳鼻咽喉头颈外科杂志,2015, 50(6): 443-447. doi:10.3760/cma.j.issn.1673-0860.2015.06.002.
[2] 中国突发性聋多中心临床研究协作组, Chinese sudden hearing loss multi-center clinical. 中国突发性聋分型治疗的多中心临床研究[J]. 中华耳鼻咽喉头颈外科杂志,2013, 48(5): 355-361. doi:10.3760/cma.j.issn.1673-0860.2013.05.002. Chinese sudden hearing loss multi-center clinical. Prospective clinical multi-center study on the treatment of sudden deafness with different typings in china[J]. Chinese Journal of Otorhinolaryngology Head and Neck Surgery, 2013, 48(5): 355-361. doi:10.3760/cma.j.issn.1673-0860.2013.05.002.
[3] 周长华, 桂明才, 徐丹, 等. 地塞米松耳后注射治疗突发性聋的临床观察[J]. 中国中西医结合耳鼻咽喉科杂志, 2016, 24(2): 99-100,98. doi:10.16542/j.cnki.issn.1007-4856.2016.02.006. ZHOU Changhua, GUI Mingcai, XU Dan, et al. The effects of postauricular dexamethasone injection for sudden hearing loss[J]. Chinese Journal of Otorhinolaryngology in Integrative Medicine, 2016, 24(2): 99-100,98. doi:10.16542/j.cnki.issn.1007-4856.2016.02.006.
[4] Crane RA, Camilon M, Nguyen S, et al. Steroids for treatment of sudden sensorineural hearing loss: a meta-analysis of randomized controlled trials[J]. Laryngoscope, 2015, 125(1): 209-217. doi:10.1002/lary.24834.
[5] Jung da J, Park JH, Jang JH, et al. The efficacy of combination therapy for idiopathic sudden sensorineural hearing loss[J]. Laryngoscope, 2016, 126(8): 1871-1876. doi:10.1002/lary.25751.
[6] 吴思恩, 李清明, 黄素红. 耳后注射甲基泼尼松龙治疗低中频下降型突发性聋的疗效观察[J]. 临床耳鼻咽喉头颈外科杂志, 2015(10): 928-930. WU Sien LI Qingming HUANG Suhong. Clinical effect on the treatment of the low-middle frequency sudden hearing loss with postaurical injection of methylprednisolone[J]. Journal of Clinical Otorhinolaryngology, 2015(10): 928-930.
[7] 静媛媛, 余力生, 李兴启, 等. 耳后注射复方倍他米松豚鼠血浆中药代动力学特征[J]. 听力学及言语疾病杂志, 2009, 17(4): 354-357. doi:10.3969/j.issn.1006-7299.2009.04.012. JING Yuanyuan, YU Lisheng, LI Xingqi, et al. Compound betameth pharmacokinetics in plasma of guinea pig after postaurieal injection[J]. Journal of Audiology and Speech Pathology, 2009, 17(4): 354-357. doi:10.3969/j.issn.1006-7299.2009.04.012.
[8] 兰龙江, 徐珏. 乳突筛区骨膜下注射甲泼尼龙琥珀酸钠治疗常规治疗失败的突发性聋[J]. 中国耳鼻咽喉头颈外科, 2014, 21(6): 287-289. LAN Longjiang, XU Jue. Clinical effect of methyllprednisolone on refractory sudden hearing loss through mastoid cribriform area subperiosteum injection[J]. Chinese Archives of Otolaryngology-Head and Neck Surgery, 2014, 21(6): 287-289.
[9] 孔维佳.耳鼻咽喉头颈外科学[M].北京:人民卫生出版社,2005:351-352.
[10] Takumida M, Anniko M. Localization of endotoxin in the inner ear following inoculation into the middle ear[J]. Acta Otolaryngol, 2004, 124(7): 772-777. doi:10.1080/00016480410017459.
[11] 苏金龙.地塞米松鼓室注射对突发性聋患者的影响[J].中国微循环,2009,13(4):303-304.
[12] 张运波, 杨艺全, 习国平, 等. 乳突骨膜下注射甲泼尼龙琥珀酸钠治疗突发性聋[J]. 听力学及言语疾病杂志, 2012, 20(4): 375-376. doi:10.3969/j.issn.1006-7299.2012.04.022.
[13] 徐鸥, 王静妙, 刘砚星, 等. 耳后注射皮质类固醇药物治疗突聋疗效分析[J]. 听力学及言语疾病杂志, 2013, 21(6): 633-634. doi:10.3969/j.issn.1006-7299.2013.06.021.
[14] 卢娜. 三种不同给药途径治疗突发性感音神经性耳聋的效果对比[J]. 山东大学耳鼻喉眼学报, 2015(2): 24-27. doi:10.6040/j.issn.1673-3770.0.2014.316. LU Na. Three different routes of administration in the treatment of sudden sensorineural hearing loss.LU Na. Department[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2015(2): 24-27. doi:10.6040/j.issn.1673-3770.0.2014.316.
[15] 高子雯, 戴艳红, 后婕, 等. 不同局部应用糖皮质激素方式在治疗难治性突发性聋的疗效观察[J]. 中华耳科学杂志, 2017, 15(6): 709-714. doi:10.3969/j.issn.1672-2922.2017.06.020. GAO Ziwen, DAI Yanhong, HOU Jie, et al. Rescue glucocorticoid treatments for refractory sudden sensorineural hearing loss[J]. Chinese Journal of Otology, 2017, 15(6): 709-714. doi:10.3969/j.issn.1672-2922.2017.06.020.
[1] 钟晓声,杨海弟,郑亿庆. 突发性聋伴耳鸣的治疗与转归[J]. 山东大学耳鼻喉眼学报, 2019, 33(4): 43-46.
[2] 赵俊英,王建明. 单侧突发性聋与椎基底动脉影像学特征的相关性研究[J]. 山东大学耳鼻喉眼学报, 2019, 33(4): 47-51.
[3] 童巧珍,赵艳,程四华. 突发性聋患者负性情绪知信行模式构建及应用效果[J]. 山东大学耳鼻喉眼学报, 2019, 33(4): 162-164.
[4] 刘建波,张环. 超声乳化联合玻璃体腔药物注射治疗白内障合并糖尿病性黄斑水肿[J]. 山东大学耳鼻喉眼学报, 2019, 33(2): 99-104.
[5] 杜经纬,冯俊,马鹏,李志勇,李红光. 鼻腔冲洗联合鼻用糖皮质激素对AR患者FeNO、肺功能及生活质量的影响[J]. 山东大学耳鼻喉眼学报, 2019, 33(1): 124-127.
[6] 许明,罗兴谷,唐洪波,江青山. 儿童突发性聋的临床特征及预后相关因素分析[J]. 山东大学耳鼻喉眼学报, 2018, 32(5): 41-44.
[7] 陈伟,胡中南,童钊君,李湘宇,刘文君. 青中年无眩晕、心脑血管疾病病史的突发性聋患者高刺激率听性脑干反应特征分析[J]. 山东大学耳鼻喉眼学报, 2018, 32(5): 45-49.
[8] 朱文燕,金新,佘万东,马永驰. 突发性聋30例精神心理状况分析[J]. 山东大学耳鼻喉眼学报, 2018, 32(5): 50-52.
[9] 孟立新,李健,韦善文. 鼓膜微管置入术治疗中耳不张76例临床分析[J]. 山东大学耳鼻喉眼学报, 2018, 32(5): 61-65.
[10] 黄颖铭,万保罗,靳钰炜. 复方倍他米松联合盐酸利多卡因辅助治疗突发性聋的疗效观察[J]. 山东大学耳鼻喉眼学报, 2018, 32(4): 11-13.
[11] 黄凯丰. 糖皮质激素短疗程雾化吸入对嗜酸粒细胞性鼻窦炎伴鼻息肉患者鼻部症状及肾上腺皮质功能的影响[J]. 山东大学耳鼻喉眼学报, 2018, 32(4): 28-31.
[12] 李华斌, 赖玉婷. 慢性鼻-鼻窦炎的发病机制及诊疗进展[J]. 山东大学耳鼻喉眼学报, 2018, 32(3): 4-9.
[13] 高进良,年婉清,李烁. 鼻内镜手术联合鼻用糖皮质激素治疗腺样体肥大性[J]. 山东大学耳鼻喉眼学报, 2018, 32(2): 38-42.
[14] 谢洪彬,杨美娜,陈青山,刘旭阳,樊宁. IgG4相关性眼病伴继发性青光眼病例分析[J]. 山东大学耳鼻喉眼学报, 2018, 32(2): 99-102.
[15] 张玉波,岳丽艳,尹晓妍,吕哲,单春光. 耳鸣治疗仪联合银杏叶提取物注射液治疗突聋伴耳鸣的疗效分析[J]. 山东大学耳鼻喉眼学报, 2017, 31(5): 50-53.
Viewed
Full text


Abstract

Cited

  Shared   
  Discussed   
[1] 公 蕾,孙 洁,薛子超,李敬华,薛卫国 . 鼻腔鼻窦恶性肿瘤细胞周期的DNA分析[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 193 -195 .
[2] 陈文文 . 1例T/NK淋巴瘤17年演进[J]. 山东大学耳鼻喉眼学报, 2006, 20(5): 472 -472 .
[3] 马敬, 钟翠萍 . 手术治疗侵犯翼腭窝的鼻咽纤维血管瘤的方法(附5例报告)[J]. 山东大学耳鼻喉眼学报, 2006, 20(1): 30 -32 .
[4] 刘强和,罗香林,耿宛平,陈 晨,雷 迅,刘芳贤,邓 明 . 快速老化小鼠的听功能和耳蜗螺旋神经元的增龄性变化[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 215 -217 .
[5] 郑鹏凌,陈卫国,易笃友,黄清秀,卢 俊 . 耳内镜下吸引清除耳道耵聍55例并文献复习[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 223 -226 .
[6] 马 敬,钟翠萍,严 星,安 飞 . 耳屏软骨修补无残余软骨的鼻中隔穿孔15例[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 246 -247 .
[7] 崔哲洙,严永峰,崔春莲,金顺吉 . 嗜酸性粒细胞在变应性鼻炎合并慢性鼻窦炎的分布特点[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 250 -252 .
[8] 赵鲁新,翟 洪,潘 洁 . 超声乳化吸除联合晶状体植入治疗急性闭角型青光眼伴白内障23例[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 260 -262 .
[9] 杨志强,王改霞 . 新型弹性开放袢前房型人工晶状体植入术27例[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 269 -270 .
[10] 王 旭,张 华,吕丽萍,崔 磊,李 淼 . 济南市上网青少年泪膜质量调查[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 265 -268 .