耳内窥镜下鼓室内注射甲强龙对伴眩晕突聋患者听力康复及前庭功能和凝血功能的影响
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摘要
目的探讨耳内窥镜下鼓室内注射甲强龙对伴眩晕突聋患者听力康复及前庭功能和凝血功能的影响。方法以2014年3月至2017年6月铜川市人民医院收治的62例伴眩晕突聋患者为研究对象。根据治疗方案不同将所有患者分为对照组和观察组各31例。所有患者均给予改善内耳微循环、降低血黏度和抗凝等常规治疗。对照组在常规治疗基础上采取甲强龙静脉注射治疗。观察组在常规治疗基础上给予耳内镜下鼓室注射甲强龙治疗,均治疗10 d。分析对比两组的治疗总有效率和治疗前后的凝血功能和前庭功能情况,采用血浆凝固法对凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)和纤维蛋白原(FIB)进行测定。结果观察组的治疗总有效率为77.42%,高于对照组的54.84%,差异有统计学意义(P<0.05)。耳内窥镜下鼓室内注射甲强龙对前庭功能正常患者的治疗总有效率77.78%,高于对前庭功能异常患者的治疗总有效率38.46%(P<0.05)。治疗前,两组之间的前庭功能情况差异均无统计学意义;对照组治疗后的前庭功能情况差异无统计学意义;观察组治疗后的前庭功能正常占比高于治疗前,同组治疗前后比较差异有统计学意义(P<0.05)。治疗前,两组的PT、APTT、TT和FIB水平不具有统计学差异;治疗后,两组治疗后的PT、APTT和TT水平高于且FIB水平低于治疗前,同组治疗前后比较差异有统计学意义(P<0.05);观察组的PT、APTT和TT水平高于且FIB水平低于对照组,差异有统计学意义(P<0.05)。结论耳内窥镜下鼓室内注射甲强龙治疗伴眩晕突聋,有利于患者听力康复,能一定程度上改善前庭功能和凝血功能,但该研究的不足之处在于样本量较少,需要扩大样本量做进一步研究。
Objective To discuss the effects of methylprednisolone indoor injection under endoscope on hearing recovery,vestibular function and blood coagulation function of sudden deafness patients with vertigo. Methods A total of 62 sudden deafness patients with vertigo treated in our hospital from March 2014 to June 2017 were selected as research objects and were divided into control group(31 cases) and observation group(31 cases). And the patients were also divided into normal vestibular function group(38 cases) and abnormal vestibular function group(23 cases) according to frequency-eye seismogram(VNG) inspection. The total efficiency, vestibular function and blood coagulation function of two groups were compared. And the total efficiency of different vestibular function patients treated with methylprednisolone indoor injection under endoscope were compared. Results The total efficiency of observation group was higher than control group(P < 0.05). The total efficiency of normal vestibular function group treated with methylprednisolone indoor injection under endoscope was higher than abnormal vestibular function group(P < 0.05). The difference in vestibular function of two groups was no statistically significant(P < 0.05). The difference in vestibular function of control group before and after treatment showed no no statistically significant(P < 0.05). The normal vestibular function proportion of observation group after treatment was higher than that before treatment(P < 0.05). Before treatment, prothrombin time(PT), activation of partial thrombin time(APTT), thrombin time(TT) and fibrinogen(FIB) of two groups were not statistically significant. After treatment, PT, APTT and TT levels of observation group were higher and FIB level was lower than those of the control group(P < 0.05). The PT, APTT and TT levels of observation group after treatment were higher and FIB level was lower than those before treatment(P < 0.05). Conclusion The sudden deafness patients with vertigo treated with methylprednisolone indoor injection under endoscope contributes to the hearing recovery, improve vestibular function and coagulation function. However, the deficiency of this research is that the sample size is relatively small, so it is necessary to expand the sample size for further study.
Objective To discuss the effects of methylprednisolone indoor injection under endoscope on hearing recovery,vestibular function and blood coagulation function of sudden deafness patients with vertigo. Methods A total of 62 sudden deafness patients with vertigo treated in our hospital from March 2014 to June 2017 were selected as research objects and were divided into control group(31 cases) and observation group(31 cases). And the patients were also divided into normal vestibular function group(38 cases) and abnormal vestibular function group(23 cases) according to frequency-eye seismogram(VNG) inspection. The total efficiency, vestibular function and blood coagulation function of two groups were compared. And the total efficiency of different vestibular function patients treated with methylprednisolone indoor injection under endoscope were compared. Results The total efficiency of observation group was higher than control group(P < 0.05). The total efficiency of normal vestibular function group treated with methylprednisolone indoor injection under endoscope was higher than abnormal vestibular function group(P < 0.05). The difference in vestibular function of two groups was no statistically significant(P < 0.05). The difference in vestibular function of control group before and after treatment showed no no statistically significant(P < 0.05). The normal vestibular function proportion of observation group after treatment was higher than that before treatment(P < 0.05). Before treatment, prothrombin time(PT), activation of partial thrombin time(APTT), thrombin time(TT) and fibrinogen(FIB) of two groups were not statistically significant. After treatment, PT, APTT and TT levels of observation group were higher and FIB level was lower than those of the control group(P < 0.05). The PT, APTT and TT levels of observation group after treatment were higher and FIB level was lower than those before treatment(P < 0.05). Conclusion The sudden deafness patients with vertigo treated with methylprednisolone indoor injection under endoscope contributes to the hearing recovery, improve vestibular function and coagulation function. However, the deficiency of this research is that the sample size is relatively small, so it is necessary to expand the sample size for further study.
引文
[1]雍军,王咏峰,贾艳辉.突发性聋210例原因及疗效分析[J].山西医药杂志,2017,46(1):77-79.
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[16]成斌.鼠神经生长因子治疗突发性耳聋的疗效观察[J].中国医学前沿杂志:电子版,2014,6(4):104-106.
[17]赵红.突发性聋伴眩晕患者的前庭功能评价及对预后评估意义[J].中国医刊,2016,51(9):88-91.
[18]王刚强,郑善銮.巴曲酶对突发性耳聋患者凝血及纤维蛋白溶解功能的影响[J].国际检验医学杂志,2014,35(10):1268-1269.
[19]康鹏德,裴福兴,沈彬,等.大剂量糖皮质激素对兔体内血小板、内皮细胞微粒变化及凝血功能影响与骨坏死关系的研究[C].全国髋关节外科学术研讨会.2006.
[20]张永平.不同给药途径治疗突发性神经性耳聋的疗效观察[J].医药论坛杂志,2016,11(10):103-104.
[2]周启瑞.血白细胞升高突聋患者预后及发病机制探讨[D].合肥:安徽医科大学,2016.
[3]管红霞,张志坚,江洋,等.糖皮质激素治疗突发性聋的研究进展[J].中国医药导报,2016,13(5):41-45.
[4]中华耳鼻咽喉头颈外科杂志编辑委员会.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.
[5]岑迎贺.耳内镜下鼓室注射甲强龙治疗中重度突发性耳聋的疗效观察[J].中国现代药物应用,2017,11(12):103-105.
[6]肖娟.视频眼震电图对突发性聋伴眩晕患者前庭功能的诊断价值[J].世界临床医学,2016,10(8):75-76.
[7]马天宝,徐芝芳.突发性耳聋伴眩晕的临床特征探讨[J].中国实用医药,2016,11(18):180-181.
[8]王剑,邱建华.一氧化氮和心钠素对耳蜗血流的影响[J].中华耳科学杂志,2006,4(3):234-237.
[9]周小英,白忠.突发性聋与内耳微循环障碍的相关性研究进展[J].临床医学,2015,35(09):122-124.
[10]Shimazaki T,Ichimiya I,Suzuki M,et al.Localization of glucocorticoid receptors in the murine inner ear[J].Ann Otol Rhinol Laryngol,2002,111(12 Pt 1):1133.
[11]张志坚,王新春,廖华,等.糖皮质激素的不同给药途径及时机对重度和极重度突发性聋疗效的影响[J].听力学及言语疾病杂志,2011,19(6):529-531.
[12]屈永涛,陈红耀,张慧平,等.不同途径激素给药治疗突发性聋的疗效分析[J].临床耳鼻咽喉头颈外科杂志,2015,10(04):324-326.
[13]徐春来.糖皮质激素三种给药途径治疗突发性耳聋疗效分析[J].吉林医学,2017,38(6):1114-1115.
[14]郑国君,王艳,杜慧慧.糖皮质激素不同给药途径治疗低频型特发性突聋疗效分析[J].浙江创伤外科,2016,21(1):77-79.
[15]吴龙军,黄益灯,夏思文.经圆窗膜局部给药治疗内耳疾病研究进展[C].浙江省医学会耳鼻咽喉头颈外科学学术年会.2014.
[16]成斌.鼠神经生长因子治疗突发性耳聋的疗效观察[J].中国医学前沿杂志:电子版,2014,6(4):104-106.
[17]赵红.突发性聋伴眩晕患者的前庭功能评价及对预后评估意义[J].中国医刊,2016,51(9):88-91.
[18]王刚强,郑善銮.巴曲酶对突发性耳聋患者凝血及纤维蛋白溶解功能的影响[J].国际检验医学杂志,2014,35(10):1268-1269.
[19]康鹏德,裴福兴,沈彬,等.大剂量糖皮质激素对兔体内血小板、内皮细胞微粒变化及凝血功能影响与骨坏死关系的研究[C].全国髋关节外科学术研讨会.2006.
[20]张永平.不同给药途径治疗突发性神经性耳聋的疗效观察[J].医药论坛杂志,2016,11(10):103-104.