糖皮质激素局部注射与全身应用在特发性突发性聋分型治疗中的疗效  

Topical injection and systemic application of glucocorticoids in the treatment of idiopathic sudden sensorineural hearing loss by type

作　　者：王明明[1] 樊兆民[1] 侯志强[1] 张道宫[1] 王海波[1] 

机构地区：[1]山东大学附属省立医院耳鼻咽喉头颈外科,济南250021

出　　处：《中华耳鼻咽喉头颈外科杂志》2014年第1期11-15,共5页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：山东省优秀中青年科学家科研奖励基金（BS2012YY028）

摘　　要：目的分析甲泼尼龙琥珀酸钠耳后局部注射与地塞米松全身用药在特发性突发性聋分型治疗中的疗效。方法选取特发性突聋患者438例，其中低中频型76例、中高频型43例、平坦型162例、全聋型157例，采用随机数字表法分为2组：全身激素治疗组，地塞米松10mg静脉推注，1次／d，连用3d，后续5mg静脉推注，1次／d，连用4d；局部注射治疗组，甲泼尼龙琥珀酸钠40mg耳后乳突区骨皮质下局部注射，1次／3d，至听力恢复正常或15d。采用SPSS18．0软件对各型患者的听力疗效进行分组统计分析。结果220例全身激素治疗者，痊愈66例（30．0％），显效51例（23．2％），有效39例（17．7％），无效64例（29．1％），总有效率为70．9％（156／220）；不同耳聋分型组间总有效率比较，差异无统计学性意义（x^2=1．60，P〉0．05）；全聋型的治愈率明显低于低中频型和平坦型（，值分别为10．63和15．94，P值均〈0．05）。218例局部注射治疗者，痊愈66例（30．3％），显效41例（18．8％），有效34例（15．6％），无效77例（35．3％），总有效率为64．7％（141／220）；其中低中频型与平坦型间（x^2=8．38）及全聋型间（x^2=7．28）的总有效率比较，差异具有统计学意义（P值均〈0．05）；低中频型的治愈率明显高于其他三组，差异具有统计学意义（P值均〈0．05），而中高频型与平坦型及全聋型组间比较，差异均无统计学意义（P值均〉0．05）。76例低中频型患者，采用耳后局部注射激素者的治愈率（65．0％）高于全身激素治疗者（41．7％），差异具有统计学意义（x^2=4．15，P〈0．05）；另外三型突聋患者全身激素治疗的疗效虽较局部注射有增高趋势，但差异均无统计学意义（P值均〉0．05）。结论低中频型特发性突聋患者，糖皮质激素局部注射疗效最佳；而中高频型、平坦型及全Objective To investigate the therapeutic effect of topical corticosteroids injection and systemic application in the treatment of typing idiopathic sudden sensorineural hearing loss （ISSNHL）. Methods Total of 438 patients with ISSNHL, including 76 with hearing loss in low-middle frequencies, 43 in middle-high frequencies, 162 in all frequencies and 157 in total deafness, were randomly divided into two groups, the systemic application group： dexamethasone （DEX） was applied by intravenous injection in dose of 10 mg x 3 d followed by 5 mg x 4 d, and the topical injection group： methylprednisolone sodium succinate of 40 mg was injected into cortical bone of mastoid region every three days. According to the results of pure- tone threshold audiometry, the curative effect among ISSNHL with low-middle frequencies, middle-high frequencies, all frequencies hearing loss, and total deafness were evaluated. SPSS 18.0 software was used to analyze the data. Results Among 220 patients with systemic application of DEX, 66 subjects （ 30. 0% ） cases were recovery, 51 （ 23.2% ） were excellent better, 39 （ 17.7% ） better, 64 （29, 1% ） were poor, and the total effective rate was 70. 9% （156/220）. There was no statistical difference in total effective rate of four typing subgroups （ x^2 = 1.60, P 〉 0. 05 ）. And the recovery rate in total deafness subgroup was significant lower than that in low-middle and all frequencies subgroups （x^2 = 10. 63 and 15.94 respectively, both P 〈 0. 05）. In the topical injection group, the recovery rate was 30. 3% （66 cases） , excellent better 18.8% （41）, better 15.6% （34）, poor 35.3% （77）, and the total effective rate was 64. 7% （141/220）. There were statistical differences of total effective rate in low-middle frequencies in comparison with that in all frequencies（ X2 = 8.38 ） and total deafness （ x^2 = 7. 28 ） subgroups （ both P 〈 0. 05 ）. Regarding recovery rate, there were significant differences between each two typing subg

关 键 词：听觉丧失 突发性 糖皮质激素类 投药途径 

分 类 号：R764.43[医药卫生—耳鼻咽喉科]