CAJ | 학술논문

目的：分析妊娠期突发性聋临床表现特点，探讨安全有效的治疗措施。方法分析2005年6月到2013年12月间21例妊娠期突发性聋的临床表现特点及诊疗经过、疗效。突发性聋的诊断及疗效评估参照2005年济南会议的标准，治疗过程中观察纯音听力恢复情况。治疗方案：发病3天以内中度以下低中频型聋2例，首选门诊随诊观察，其余19例选择药物治疗：①低分子右旋糖酐-40500ml静脉点滴每天1次，14天为1疗程，听力恢复则随时停药；同时口服强的松，按照1mg/kg体重开始，每日总量不超过60mg,其后每3天减少10mg；如低分子右旋糖酐-40皮试过敏，改备用方案：②葛根素注射液250ml静脉点滴及口服强的松,疗程同方案①。治疗过程由产科医生负责超声监测胎儿是否存在畸形、宫内发育迟缓、低体重。对经治病例进行半年以上的母婴健康状况随访，内容为母亲听力及肝肾功能、儿童的生长发育、智力及听力言语情况。结果治疗前纯音听力曲线包括低中频下降型6例（6耳）、平坦型7例（7耳）、全聋5例（5耳）、覆盆型1例（1耳）、峰型1例（双耳），槽型1例（1耳）。痊愈13例，显效3例，有效2例，无效3例。随访0.5～5年，母婴健康。结论妊娠期间突发性聋的治疗需谨遵孕妇用药原则，低分子右旋糖酐、葛根素及强的松治疗妊娠期间突发性耳聋的疗效显著，在治疗及随访期内未发现明显不良反应,中度以下低中频型聋有自愈倾向，发病3天以内的患者可首选门诊随诊观察。
목적：분석임신기돌발성롱림상표현특점，탐토안전유효적치료조시。방법분석2005년6월도2013년12월간21례임신기돌발성롱적림상표현특점급진료경과、료효。돌발성롱적진단급료효평고삼조2005년제남회의적표준，치료과정중관찰순음은력회복정황。치료방안：발병3천이내중도이하저중빈형롱2례，수선문진수진관찰，기여19례선택약물치료：①저분자우선당항-40500ml정맥점적매천1차，14천위1료정，은력회복칙수시정약；동시구복강적송，안조1mg/kg체중개시，매일총량불초과60mg,기후매3천감소10mg；여저분자우선당항-40피시과민，개비용방안：②갈근소주사액250ml정맥점적급구복강적송,료정동방안①。치료과정유산과의생부책초성감측태인시부존재기형、궁내발육지완、저체중。대경치병례진행반년이상적모영건강상황수방，내용위모친은력급간신공능、인동적생장발육、지력급은력언어정황。결과치료전순음은력곡선포괄저중빈하강형6례（6이）、평탄형7례（7이）、전롱5례（5이）、복분형1례（1이）、봉형1례（쌍이），조형1례（1이）。전유13례，현효3례，유효2례，무효3례。수방0.5～5년，모영건강。결론임신기간돌발성롱적치료수근준잉부용약원칙，저분자우선당항、갈근소급강적송치료임신기간돌발성이롱적료효현저，재치료급수방기내미발현명현불량반응,중도이하저중빈형롱유자유경향，발병3천이내적환자가수선문진수진관찰。
Objectives To report clinical characteristics of sudden sensorineural hearing loss in pregnant women and dis-cuss on safe and effective treatments for this special population. Methods This is a retrospective analysis of characteristics, treatment procedures and effectiveness in 21 pregnant women with sudden deafness seen from June 2005 to December 2013. The criteria of 2005 Jinan conference was used for diagnosis of sudden deafness. The treatment effectiveness and hearing recov-ery were recorded during the treatment. Treatment protocols:Careful watching in the outpatient office with no treatment was the approach in 2 cases with only low-mid frequency hearing loss of 3 days or less. The rest 19 cases received either daily intrave-nous injection of low molecular dextran-40 (500 ml for a course of 14 days) with oral prednisone (starting at 1 mg/kg to a maxi-mum of 60 mg/day followed by a 10 mg reduction every 3 days), or puerarin injectable (250 ml daily) and same oral prednisone as above for those who were allergic to low molecular dextran-40. The treatment would be stopped upon determination of hear-ing recovery. Ultrasound was used to monitor for fetal deformity, hypoevolutism or low body weight during treatment by an ob-stetrician. The conditions of the mother and baby were followed up for more than 6 months, including the mother’s liver and re-nal functions and hearing, and the growth development, intelligence and hearing of the baby. Results Hearing evaluation before treatment showed low-mid frequency sloping loss (n=6), flat loss (n=7), total loss (n=5), basin shaped loss (n=1), peak shaped loss (n=1), and groove shaped low (n=1). Post-treatment hearing showed complete recovery in 13 cases, significant recovery in 3 cases, partial recovery in 2 cases, and no recovery in 3 cases. All mothers and babies were in excellent health after a period of 6 months to 5 years follow-up. Conclusions Treatment in pregnant women with sudden deafness must be individualized. Low molecular dextran-40, prednisone and puerarin are effective and safe in these patients with little adverse reactions in either the mother or the fetus. Mild and moderate low-mid frequency sudden deafness is prone to recover spontaneously. Careful observa-tion and follow-up on an outpatient basis is the first choice for the patients whose sudden deafness is less than 3 days.