CAJ | 학술논문

目的探讨分析巾高频下降型突发性聋患者药物治疗的疗效.方法采用国际通用的标准化临床研究方法进行前瞻性临床多中心研究,收集年龄18 ～65周岁,病程在2周以内,未经任何相关医疗处理的中高频下降型突发性聋病例(纯音测听2000 Hz以上频率听力下降15 dB HL以上),根据统一设计的随机表,随机选取四种治疗方案中的一种进行治疗,并对疗效进行统计分析.结果 141例中高频下降型突发性聋患者,随机选取治疗方案,利多卡因组20例,利多卡因+糖皮质激素组21例,银杏叶提取物(金纳多)组40例,金纳多+糖皮质激素组60例.治疗1个月后随访,耳聋痊愈42例(29.79％),显效24例(17.02％),有效27例(19.15％),无效48例(34.04％),总有效率为65.96％.各治疗方案组的总有效率分别为:利多卡因组55.00％,利多卡因+激素组66.67％,金纳多组67.50％,金纳多+激素组68.33％,组间比较,差异无统计学意义(x2=7.17,P＞0.05),但治愈率比较,金纳多组明显优于利多卡因组(P =0.0496).119例伴有耳鸣者,耳鸣改善总有效率为81.51％,各治疗组的总有效率分别是利多卡因组57.89％(11/19),利多卡因+激素组100.00％(18/18),金纳多组88.57％(31/35),金纳多+激素组78.72％(37/47)；组间两两比较,利多卡因+激素组耳鸣疗效优于利多卡因组(P =0.002)和金纳多+激素组(P =0.029),利多卡因组和金纳多组间差异亦具有统计学意义(x2=6.705,P＜O.05).43例伴耳闷者,治疗总有效率90.70％,各组间有效率比较差异无统计学意义(x2=5.97,P=0.74).17例伴头晕或眩晕者及10例伴有其他不适症状者,治疗后症状改善总有效率均为100.00％.结论对于中高频下降型突发性聋患者,四种药物治疗方案均有效,单从治愈率角度出发,推荐使用金纳多；中高频下降型突发性聋伴发症状以耳鸣为主,治疗上首选利多卡因+激素方案.
목적 탐토분석건고빈하강형돌발성롱환자약물치료적료효.방법 채용국제통용적표준화림상연구방법진행전첨성림상다중심연구,수집년령18 ～65주세,병정재2주이내,미경임하상관의료처리적중고빈하강형돌발성롱병례(순음측은2000 Hz이상빈솔은력하강15 dB HL이상),근거통일설계적수궤표,수궤선취사충치료방안중적일충진행치료,병대료효진행통계분석.결과 141례중고빈하강형돌발성롱환자,수궤선취치료방안,리다잡인조20례,리다잡인+당피질격소조21례,은행협제취물(금납다)조40례,금납다+당피질격소조60례.치료1개월후수방,이롱전유42례(29.79％),현효24례(17.02％),유효27례(19.15％),무효48례(34.04％),총유효솔위65.96％.각치료방안조적총유효솔분별위:리다잡인조55.00％,리다잡인+격소조66.67％,금납다조67.50％,금납다+격소조68.33％,조간비교,차이무통계학의의(x2=7.17,P＞0.05),단치유솔비교,금납다조명현우우리다잡인조(P =0.0496).119례반유이명자,이명개선총유효솔위81.51％,각치료조적총유효솔분별시리다잡인조57.89％(11/19),리다잡인+격소조100.00％(18/18),금납다조88.57％(31/35),금납다+격소조78.72％(37/47)；조간량량비교,리다잡인+격소조이명료효우우리다잡인조(P =0.002)화금납다+격소조(P =0.029),리다잡인조화금납다조간차이역구유통계학의의(x2=6.705,P＜O.05).43례반이민자,치료총유효솔90.70％,각조간유효솔비교차이무통계학의의(x2=5.97,P=0.74).17례반두훈혹현훈자급10례반유기타불괄증상자,치료후증상개선총유효솔균위100.00％.결론 대우중고빈하강형돌발성롱환자,사충약물치료방안균유효,단종치유솔각도출발,추천사용금납다；중고빈하강형돌발성롱반발증상이이명위주,치료상수선리다잡인+격소방안.
Objective To analyze the therapeutic effect of treatment for intermediate and highfrequency sudden sensorineural hearing loss (SSNHL).Methods A prospective clinical multicentre research was conducted using international standardized approach of clinical research.SSNHL Cases with intermediate and high-frequency hearing loss,that accepted no medicationfrom onset of hearing loss withintwo weeks duration and ages ranged between 18 and 65,were collected.All patients were treated by one of four treatments plans chosen by unified random table.Results 141 patients with intermediate and high-frequency SSNHL were recruited in the research.Twenty subjects were treated with lidocaine,21 cases with lidocaine and hormone,40 cases with Ginaton,and 60 cases with Ginaton and hormone.42 out of 141 (29.79％) patients were total recovery,24 (17.02％)achieved excellent recovery,27 (19.15％)achieved partial recovery,and 48 (34.04％) were ineffective.Thc total effective rate was 65.96％.In lidocaine group,the total effective rate was 55.00％,66.67％ in lidocaine and hormone group,67.50％ in Ginaton group,and 68.33％ in Ginaton and hormone group.Considering the total effective rate,there was no statistical difference between four groups (P ＞ 0.05).However,the recovery rate in Ginaton group was significant difference comparing with that in lidocaine group (P =0.0496).119 had concomitant symptom of tinnitus,and the tinnitus was improved in patients of 81.51％.With regard to total effective ratc of tinnitus in four treatment groups,it was 57.89％ (11/19) in lidocaine group,100.00％ (18/18) in lidocaine and hormone group,88.57％ (31/35) in Ginaton group,78.72％ (37/47) in Ginaton and hormone group.There was significant ascendency in lidocaine and hormone group versus that in lidocaine group (P =0.002) and Ginaton and hormone group (P =0.029).And the difference between lidocaine and Ginaton groups was statistical significance (x2 =6.705,P ＜ 0.05).In 43 patients with muffled symptom in aural rcgion,90.70％ was partial recovery.There was no statistical difference between each groups (x2 =5.97,P =0.74).There were 17 with dizziness or vertigo improved in all cases.Another 10 patients accompanied other complaints all improved.Conclusions for the treat of intermediate and high-frequency SSNHL,the therapeutic effect in hearing has no significantly different between single and combined drug therapies.Considering the recovery rate,there is an obvious advantage in Ginaton group compared with lidocaine group.Tinnitus is the major concomitant symptom in intermediate and high-frequency SSNHL,and lidocaine and hormone therapy should be used.