高压氧综合治疗突发性耳聋预后相关因素分析  

Factors Relevant to the Prognosis of Patients with Sudden Deafness after Hyperbaric Oxygen Therapy

作　　者：李琴 吴嗣洪[2] 唐守英 张惠华 曹晓燕 葛秀英 

机构地区：[1]上海市奉贤区中心医院,上海201499 [2]上海交通大学附属新华医院,上海200092

出　　处：《中国听力语言康复科学杂志》2014年第3期174-177,共4页Chinese Scientific Journal of Hearing and Speech Rehabilitation

摘　　要：目的：根据临床资料建立预测高压氧（hyperbaric oxygen，HBO）综合治疗突发性耳聋（sudden deafness，SD）预后的评分模型，并评价科学性。方法连续选择188例（221耳）接受高压氧综合治疗的SD患者，随机分为两组：训练样本168例（201耳），验证样本20例（20耳）。采用自身前后对照试验方案，根据训练样本实际疗效分为有效和无效两组，应用X2检验筛选出有统计学意义的危险因素并赋值，建立评分模型，并进行受试者工作特征曲线（receiver operator characteristic curve，ROC）分析。结果 SD伴眩晕、听力曲线呈下降/全聋型、发病至就诊时间≥15 d、HBO治疗疗程＜2个疗程、HBO开始治疗时间≥15 d、就诊平均听力损失≥60 dB HL、SD合并高血压（high blood pressure，HBP）或糖尿病（diabetes mellitus，DM）或二者兼有是影响高压氧综合治疗突发性耳聋预后的危险因素。应用ROC分析该评分模型，曲线下面积（area under the curve,AUC）为0.967，与完全随机情况下获得的曲线下面积（0.5）相比有显著差异，P〈0.05。经验证样本前瞻性误判概率评估，误判率约10％。结论根据临床资料建立预测HBO综合治疗SD预后的评分模型可以预估SD预后，对临床治疗有一定指导意义。Objective To establish a scoring model that predicts the prognosis of patients with sudden deafness after hyperbaric oxygen therapy based on clinical data and to evaluate the efficacy of the model. Methods 188 patients with sudden deafness（221 ears）who received hyperbaric oxygen therapy were divided into two groups： 168 patients（201 ears） in training group and 20 patients（20 ears）in testing group. With a self-controlled experimental design, the training group were divided into the effective group and ineffective group. Chi-square test was applied to choose statistically significant risk factors which were used to establish a scoring model. Receiver operator characteristic （ROC） curve was then used to analyze the scoring model. Results The factors that had adverse effects on the prognosis of patients with sudden deafness after hyperbaric oxygen therapy included sudden deafness with vertigo, descending/completely deaf audiogram, prehospital delay time≥15 d, hyperbaric oxygen therapy＆lt;2 courses, beginning time of treatment≥fifteen days after onset, average hearing loss at the first visit≥60 dB HL, sudden deafness with HBP（high blood pressure）/DM（diabetes mellitus）or both. The ROC curve analysis revealed that the area under the curve （AUC） for the scoring model was 0.967, which was significantly different from the AUC（0.5） under the completely random circumstances（P＆lt;0.05）. The appraisal of prospective misjudge possibility was applied to the scoring model in testing samples and the results showed the misjudgement rate was about 10%. Conclusion This scoring model based on clinical data can be used to predict the prognosis of patients with sudden deafness after hyperbaric oxygen therapy.

关 键 词：突发性耳聋 高压氧治疗 预后 相关因素 

分 类 号：R595.105[医药卫生—内科学]