基于头部MRA和颈部血管超声的突发性聋预后及高压氧疗效分析  

Prognostic analysis of sudden sensorineural hearing loss based on head MRA and cervical vascular ultrasound and therapeutic evaluation of hyperbaric oxygen therapy

作　　者：李戈 霍棋棋 张奕[1] 刘雪华[1] 杨晶[1] Li Ge;Huo Qiqi;Zhang Yi;Liu Xuehua;Yang Jing(Department of Hyperbaric Medicine,Beijing Chao-Yang Hospital,Capital Medical University,Beijing 100020,China)

机构地区：[1]首都医科大学附属北京朝阳医院高压氧医学科,北京100020

出　　处：《中华航海医学与高气压医学杂志》2021年第6期761-766,共6页Chinese Journal of Nautical Medicine and Hyperbaric Medicine

摘　　要：目的探讨影响突发性聋预后的相关因素,指导突发性聋的高压氧综合治疗。方法回顾性分析2018年6月至2021年9月北京朝阳医院高压氧医学科收治的112例(115耳)突发性聋患者,根据治疗有效(痊愈+显效+有效)和无效将患者分为2组,比较2组患者头部磁共振血管成像(MRA)、颈部血管超声等相关因素,再行二元Logistic回归分析。结果有效组45例(46耳),有效率为40.0%;无效组67例(69耳)。高压氧综合治疗2个疗程后进行超声辅助检查,最后评定颈内动脉斑块53例,椎动脉斑块12例。头部磁共振成像(MRI)示脑白质病变(WMLs)53例,头部MRA示颅内血管狭窄26例。听力损失曲线类型:低频下降型12例(12耳),高频下降型16例(16耳);平坦下降型44例(45耳);全聋型40例(42耳)。听力损失程度:轻度22例(22耳),中度29例(30耳),重度17例(17耳),极重度44例(46耳)。2组患者发病到首次治疗时间、听力损失类型及听力损失程度比较差异有统计学意义(P<0.01)。Logistic回归分析结果显示,听力损失类型、发病到首次治疗时间与突发性聋预后具有相关性(P<0.01)。结论早期高压氧综合治疗不同频率听力损失的预后更好,伴有颅内血管狭窄患者的预后较差,突发性聋伴有头部MRA异常的患者需要更多关注。Objective To investigate the factors affecting the prognosis of sudden sensorineural hearing loss(SSNHL),so as to guide the comprehensive treatment combined with hyperbaric oxygen(HBO)on SSNHL.Methods A retrospective analysis was conducted on 112 patients(115 ears)with SSNHL who were admitted to the Department of Hyperbaric Medicine of Beijing Chao-yang Hospital from June 2018 to September 2021.They were divided into effective group(cured+markedly effective+effective)and ineffective group.The factors,i.e.,head magnetic resonance angiography(MRA)and neck vascular ultrasound,were compared between the two groups,and then binary logistic regression analysis was performed.Results There were 45 cases(46 ears)in the effective group,67 cases(69 ears)in the ineffective group,and the effective rate was 40.0%.After two courses of HBO treatment,ultrasound-assisted examination was performed.Internal carotid artery plaques were found in 53 cases and vertebral artery plaques were found in 12 cases.Head MRI showed white matter lesions(WMLs)in 53 cases and MRA showed intracranial vascular stenosis in 26 cases.Types of hearing loss curves:12 cases(12 ears)were hearing loss in low tone frequencies,16 cases(16 ears)were hearing loss in high tone frequencies;44 cases(45 ears)were hearing loss in all tone frequencies;and 40 cases(42 ears)were total deafness.Hearing loss degree:22 cases(22 ears)were mild,29 cases(30 ears)were moderate,17 cases(17 ears)were severe,and 44 cases(46 ears)were extremely severe.The time from onset to first treatment,the type of hearing loss,and the degree of hearing loss between the two groups were significantly different(P<0.01).Logistic regression analysis showed that the type of hearing loss and the time from onset to first treatment were correlated with the prognosis of SSNHL(P<0.01).Conclusion The prognosis of SSNHL with early HBO intervention was better,while the prognosis of SSNHL patients with intracranial vascular stenosis was poor.The SSNHL patients with abnormal head MRA results need more attentio

关 键 词：突发性聋 高压氧 血管因素 预后 

分 类 号：R764.437[医药卫生—耳鼻咽喉科]