CAJ | 학술논문

目的探讨人工耳蜗植入后由植入体引发局部反应的发生率、症状、体征,分析其可能的病因、相关因素以及对患者的影响和主要的处理原则,为临床工作提供参考和借鉴.方法回顾分析1995年9月至2007年7月植入多道人工耳蜗患者997例中由植入体引发局部反应的10例患儿的症状、体征、治疗及预后情况.结果 997例中有10例术后出现局部反应,发病率1.003%.10例中男6例,女4例.植入时年龄13个月至8岁,平均34个月.植入装置分别为Cochlear和Med-EL公司产品,各5例.首次发病时间为术后1个月至8年,平均为2年4个月.发病时年龄小于4岁的8例,大于5岁的2例.主要症状及体征为:植入侧局部肿胀、耳后不适、瘙痒感,触及有波动感,有的患儿局部有红点,声音清晰度下降等.发病次数为1～8次,平均2.4次.局部抽出液细菌培养阴性,2例经IgE检测示患者为中度过敏体质.有姐弟俩术后均有发病.除1例多次发病最后取出装置外,其余均经抗生素、抗组胺及激素等保守治疗有效.结论人工耳蜗植入患者术后植入侧局部出现反应的发生率并不高,而反复出现相同症状的更少.主要病因除局部感染所致外,可能同植入体引发的局部变态反应有关.确诊该病目前虽有一定的难度,但术前过敏源筛查仍有必要.对于有过敏体质者,即使筛查阴性,术后仍需密切随访.对出现症状的患者除首先进行积极的保守治疗外,仍有必要进一步进行变态反应试验以确诊.必要时可给予抗免疫治疗.如继发严重细菌感染不能控制者,则应尽快取出体内装置,待病情稳定后选择无致敏原装置再次植入.发病年龄以4岁以下儿童多见.
목적 탐토인공이와식입후유식입체인발국부반응적발생솔、증상、체정,분석기가능적병인、상관인소이급대환자적영향화주요적처리원칙,위림상공작제공삼고화차감.방법 회고분석1995년9월지2007년7월식입다도인공이와환자997례중유식입체인발국부반응적10례환인적증상、체정、치료급예후정황.결과 997례중유10례술후출현국부반응,발병솔1.003%.10례중남6례,녀4례.식입시년령13개월지8세,평균34개월.식입장치분별위Cochlear화Med-EL공사산품,각5례.수차발병시간위술후1개월지8년,평균위2년4개월.발병시년령소우4세적8례,대우5세적2례.주요증상급체정위:식입측국부종창、이후불괄、소양감,촉급유파동감,유적환인국부유홍점,성음청석도하강등.발병차수위1～8차,평균2.4차.국부추출액세균배양음성,2례경IgE검측시환자위중도과민체질.유저제량술후균유발병.제1례다차발병최후취출장치외,기여균경항생소、항조알급격소등보수치료유효.결론 인공이와식입환자술후식입측국부출현반응적발생솔병불고,이반복출현상동증상적경소.주요병인제국부감염소치외,가능동식입체인발적국부변태반응유관.학진해병목전수유일정적난도,단술전과민원사사잉유필요.대우유과민체질자,즉사사사음성,술후잉수밀절수방.대출현증상적환자제수선진행적겁적보수치료외,잉유필요진일보진행변태반응시험이학진.필요시가급여항면역치료.여계발엄중세균감염불능공제자,칙응진쾌취출체내장치,대병정은정후선택무치민원장치재차식입.발병년령이4세이하인동다견.
Objective To approach the incidence rate,symptoms,etiologies,correlating reasons,consequences and treatments of loval responses caused by implant after cochlear implantation and to provide reference for the future works.Methods From 1995 to 2007 there were 997 cases adopted cochlear implantation in Peding Union Medical CoUege Hospital.Ten cases experienced local responses were analyzed retrospectively.Results The incidence of local response was 1.003%.There were 6 males and 4 females.The ages were between 13 months to 8 years old.The average age Was 34 months.The devices mainly were made by Cochlear and Med-EL companies.The mainly symptoms and signs were local swellings,complaint of pruritus after ear,decrease of sound legibility and so on.Onset frequencies of this disease Was 1 to 8 times.The bacterium cultured of displacing liquids Was negative.But the IgE was detected in 2 cases.Results showed the patients were midrange status of hypersensitivity.Positive conservative treatments must be done including antibiotics,antihistamines,necessarily using immunotherapy.Conclusions Besides local infection of bacteria,the allergy caused by silicone of implant couled be a reason.Although the diagnose of this disease was difficult,but the screening of source of hypersensitivity was necessary before operation.Itwas recurrent attacks and maybe liable by kindred patients.Onset age was more below 4 years old.The patch test should be done again when the symptoms were occurrence after operation.If severe secondary infection was occurred and the states could not be well controlled the devices in the body must be explanted immediately.When the condidons were stable reimplantation could be experienced by non-sensibilisinogen devices.