摘要
目的探讨全聋型突发性聋的药物治疗。方法采用前瞻性临床多中心、随机、单盲法研究,纳入年龄18—65周岁,病程2周内,未经任何相关医疗处理的全聋型突发性聋患者(纯音测听全部频率听阂升高,500、1000、2000、4000Hz平均听阈1〉81dBHL)。按各分中心随机数字表,随机选取四种治疗方案(巴曲酶,巴曲酶+银杏叶提取物,巴曲酶+银杏叶提取物+糖皮质激素和银杏叶提取物+糖皮质激素)中的一种对患者进行治疗。结果2007年8月至2011年10月,全国33家医院按标准共纳入符合条件的单侧全聋型突发性聋276例,其中男135例(48.91%),女141例(51.09%);平均年龄(41.7±13.3)岁。治疗后,听力痊愈40例(14.49%),显效78例(28.26%),有效76例(27.54%),无效82例(29.71%),总有效率为70.29%。四种治疗方案中,总有效率分别为73.33%、61.43%、78.31%和67.95%,组间比较差异无统计学意义(X2=9.97,P=0.62)。四组中耳聋痊愈率分别为11.11%、12.86%、16.87%和15.38%,使用激素的两组好于未使用者。全聋型突发性聋患者中耳呜伴发率为92.39%,晕(头晕或眩晕)伴发率为44.93%,耳闷伴发率为50.36%;这些伴发症状的疗效在四种治疗方案中,组间差异无统计学意义(P值均〉0.05)。结论全聋型突发性聋患者听力损失重,治疗有效率达70%,值得积极治疗;但痊愈率仅14%,医患对此应有合理预期。激素对提高耳聋痊愈率可能有一定作用,推荐使用。
Objective To assess the results of drug therapy in patients with severe idiopathic sudden sensorineural hearing loss (ISSHL) with total frequency hearing loss. Methods A prospective randomized, single blind, multi-center clinical trial was designed. The untreated patients with ISSHL were included, who had severe hearing loss (pure tone audiometry showed patients had total frequency hearing loss, and their mean auditory threshold of 500, 1000, 2000, 4000 Hz was beyond 81 dB HL ), age between 18 to 65 years old, and within 14 days of the onset . The patients were divided into one of the four drug groups [ batroxobin, batroxobin + ginkgo biloba leaves extract ( EGb), batroxobin + EGb + glucocorticoids, EGb + glucocorticoids ] according to the random table, and receive treatment. Results Totally 276 patients with unilateral severe ISSHL were included from 33 hospitals, from August 2007 to October 2011. Among them, male patients accounted for 135 (48.91%), female 141 (51.09%) ; the average age was (41.7 ± 13.3 ) years. Forty cases were recovered ( 14.49% ) ,78 cases had marked effective (28.26 % ), 76 cases were effective(27.54% ), 82 cases were in- effective(29.71% ), and the total effective rate was 70. 29%. Among four drug groups, the separate effective rate were 73.33% , 61.43%, 78.31% and 67.95 % respectively, no significant difference was found between groups (X2 = 9.97, P = 0. 62). Among the four groups, the separate cure rate for hearing loss were 11.11%, 12.86%, 16.87% and 15.38%, theglucocorticoid groups were significantly better than those not used. Among severe sudden deafness patients, 92. 39% cases accompanied with tinnitus, 44. 93% with dizziness (or vertigo) , 50. 36% with ear stuffy. There had no significant difference between the four groups with accompanied symptoms ( all P 〉 0.05 ). Conclusions It is value to give active treatment to sever sudden deafness patients because of an effective rate of 70%. However, the doctors and patients should be mind of a cure rate of only 14%. Steroids are recommended bacause it may play a role in the improvement rate.
出处
《中华耳鼻咽喉头颈外科杂志》
CAS
CSCD
北大核心
2013年第5期379-384,共6页
Chinese Journal of Otorhinolaryngology Head and Neck Surgery
关键词
听觉丧失
突发性
测听法
纯音
随机对照试验
药物疗法
Hearing loss, sudden
Audiometry, pure-tone
Randomized controlled trial
Drug therapy
作者简介
本研究总负责单位和负责人解放军总医院耳鼻咽喉头颈外科韩东一协作组成员(各单位按贡献大小及提供有效病例多少排序,其主要负责人列于首位)北京大学人民医院耳鼻咽喉科(余力生、夏瑞明、刘燕、韩琳、静媛媛),科研处(陈捷);解放军总医院耳鼻咽喉头颈外科(杨仕明、韩东一、杨伟炎);四川大学华西医院耳鼻咽喉头颈外科(郑虹、戴晴晴、周莲、冯宁宇);福建医科大学附属第一医院耳鼻咽喉科(张榕、陈国郝、王英歌、叶胜难、林昶、程金妹);山东省立医院集团眼耳鼻喉医院耳鼻咽喉头颈外科(王海波、王明明、樊兆民、罗建芬、侯志强、艾毓);中山大学孙逸仙纪念医院耳鼻咽喉科(郑亿庆、区永康、许耀东、张雪媛);中南大学耳科研究所湘雅二医院耳鼻咽喉头颈外科(任基浩、殷团芳、谢鼎华、刘伟、伍伟景);天津市第一中心医院耳鼻咽喉头颈外科(林鹏、赵晖、董红、程岩、马元煦);北京大学第一医院耳鼻咽喉科(王军、肖水芳);中国医学科学院北京协和医学院北京协和医院耳鼻咽喉科(高志强、倪道凤、商莹莹、陈晓巍、姜鸿、徐春晓);上海交通大学医学院附属新华医院耳鼻咽喉头颈外科(吴皓、李蕴);首都医科大学附属北京同仁医院耳鼻咽喉头颈外科(韩德民、刘博、龚树生、陈秀伍、廉能静、张栉);中山大学附属第一医院耳鼻咽喉科医院(陈锡辉、江广理、吴旋、熊观霞、姜鸿彦、许庚);上海交通大学附属第六人民医院耳鼻咽喉科(殷善开、时海波、吴雅琴、周慧群);郑州大学第一附属医院耳鼻咽喉科(董明敏、卢伟、秦兆冰、左彬、白险峰);新疆维吾尔自治区人民医院耳鼻喉一科(张劲、郭小平、陈娟、杨丽),耳鼻喉二科(柯星星、阿不都如苏力、顾兴智、艾力根、蔡亮、谭元元);重庆医科大学附属第一医院耳鼻咽喉科(胡国华、钟时勋、钱怡);南京医科大学第一附属医院耳鼻咽喉科(赵晓埝、刘丞、1、行宽、李晓璐、陆玲、徐霞);中国医科大学附属第一医院耳鼻咽喉科(姜学钧、杨宁、田颖、惠莲、冯帅);海军总医院全军耳鼻咽喉头颈外科中心(孙建军、刘阳、林勇生、刁明芳、陈东兰);西安交通大学第二附属医院耳鼻咽喉头颈科(许珉、祝康、侯瑾、李文彦);安徽医科大学第一附属医院耳鼻咽喉头颈外科(邱建新、吴开乐、余得志、童步升);第四军医大学西京医院耳鼻咽喉头颈外科(邱建华、陈阳、温立婷、韩宇、陈俊、林颖);安徽省立医院耳鼻咽喉头颈外科(孙敬武、刘晓薇、汪银凤、孙家强);首都医科大学附属北京朝阳医院耳鼻咽喉科(王宁宇、王辉、张娟、卢云);南昌大学第二附属医院耳鼻咽喉头颈外科(刘月辉、刘红兵、郭素英);兰州大学第二医院耳鼻咽喉头颈外科(郭玉芬、徐百成);天津医科大学总医院耳鼻咽喉科(周慧芳、王鑫、杨东、许轶、张耕);复旦大学附属眼耳鼻喉科医院耳神经颅底外科(迟放鲁、赵晖、景江华);华中科技大学同济医学院附属协和医院耳鼻咽喉科(孔维佳、程华茂、师洪、刘波、肖红俊、郭长凯);卫生部北京医院耳鼻咽喉科(黄魏宁、王利一、陈宏);徐州医学院附属医院耳鼻咽喉头颈外科(刘稳);北京大学第三医院耳鼻咽喉科(潘滔、马芙蓉、汪敏、柯嘉、辛颖)
通信作者:郑虹,Email:hxzhengh@126.com;
邱建华,Email:qiujh@fmmu.edu.cn,邮政编码:710032