鼓室内应用甲基泼尼松龙和庆大霉素治疗自身免疫性膜迷路积水  

Intratympanic methylprednisolone or gentamicin for treating endolymphatic hydrops patients induced by autoimmune inner ear disorder

作　　者：仇继兵[1] 谭长强[1] 

机构地区：[1]南京医科大学第一附属医院耳鼻咽喉科,江苏南京210029

出　　处：《东南大学学报（医学版）》2012年第3期261-267,共7页Journal of Southeast University(Medical Science Edition)

基　　金：国家自然科学基金资助项目(81070789)

摘　　要：目的:了解和证实自身免疫性膜迷路积水(AIEH)患者鼓室内注射甲基泼尼松龙(MP)或庆大霉素(GM)的治疗效果和不良反应。方法:诊断AIEH 62例,随机分为MP组29例和GM组33例。经鼓室内置入临时导管,隔日注射MP 2周或隔日注射GM 4次(出现听损者立即停止)。治疗前和治疗后1周分别进行听觉和前庭功能测定。结果:依据眩晕控制和听损改善评定标准,MP组和GM组有效率分别为69%和64%。52例膜迷路积水试验转变成阴性。两组优势偏向发生率明显减少,MP组管麻痹发生率亦明显减少。结论:鼓室内应用MP治疗AIEH具有与GM相似的效果。作为针对内耳自身免疫的病因学治疗药物,局部应用MP不仅能够较好地控制临床症状,而且有助于内耳生理功能的恢复。Objective： To explore and realize the curative effect and untoward reaction for treating endolymphatic hydrops patients induced by autoimmune inner ear disorders with methylprednisolone or gentamicin locally injected into tympanic cavity. Methods： 62 cases of autoimmune endolymphatic hydrops were diagnosed. They were randomly divided into two groups, 29 cases as methylprednisolone （MP） group and 33 cases as gentamicin （GM） group. One week before and after therapy, the hearing function and vestibular function tests were performed respectively. The silica gel tube was occasionally put into tympanic cavity and fixed at round window niche. MP was injected into tympanic cavity through tubes on alternate days for two weeks. GM was injected on alternate days for 4 times. Next day following injection, the pure tone test was performed, and the injection was stopped immediately if hearing loss aggravating was found. Results： According to criteria for evaluating vertigo-control and hearing function improving, the response rate was respectively 69% in MP group and 64% in GM group Hydrolabyrinth tests were changed into negative in 52 cases, and the incidence rate of directional preponderance were reduced in two groups and the incidence rate of channel-paralysis was reduced in MP group following therapy. Conclusion： Therapeutic effects of intratympanic methylprednisolone was similar to that of intratympanic gentamicin. Targeting at autoimmune inner ear disorder, not only could methylprednisolone control clinical symptoms, but also restore inner ear physiological function.

关 键 词：自身免疫性内耳病 梅尼埃病 迟发性膜迷路积水 甲基泼尼松龙 庆大霉素 

分 类 号：R764.33[医药卫生—耳鼻咽喉科]