CAJ | 학술논문

目的：观察和比较不同疗程的鼓室内注射地塞米松补救性治疗突发性聋的疗效。方法：83例（83耳）常规方法治疗无效的突发性聋患者作为研究对象，治疗组共62例，使用地塞米松磷酸钠注射液1 mL∶5 mg鼓室内注射，每次注射0.8 mL。随机分3组，A组22耳每天1次，共7次（疗程为1周），B组20耳每周2次，共4次（疗程为2周），C组20耳每周1次，共2次（疗程为2周）。对照组（ D组21耳）为同期常规方法治疗无效且拒绝鼓室用药及其他治疗的突发性聋患者，4组治疗前听力及基本情况无显著差异（ P＞0.05）。比较各组听力恢复及并发症情况。结果：治疗完成后1月纯音测听检查，治疗组的痊愈、显效、有效、无效的例数分别为0、8、18、36例，总有效率41.94％（26／62），优于对照组的9.52％（2／21），差异有统计学意义，治疗后3组的PTA（ dB）均低于对照组。 A组和B组在疗效上无统计学差异（ P＞0.05），A组、B组疗效明显优于C组和D组（P＜0.05），在并发症发生率上A组、B组和C组差异无统计学意义（P＞0.05）。结论：鼓室内注射地塞米松补救性治疗突发性聋安全有效，由于A组治疗次数多，给患者增加了经济负担及医疗风险，因此推荐B组，即2周4次的治疗方案。
목적：관찰화비교불동료정적고실내주사지새미송보구성치료돌발성롱적료효。방법：83례（83이）상규방법치료무효적돌발성롱환자작위연구대상，치료조공62례，사용지새미송린산납주사액1 mL∶5 mg고실내주사，매차주사0.8 mL。수궤분3조，A조22이매천1차，공7차（료정위1주），B조20이매주2차，공4차（료정위2주），C조20이매주1차，공2차（료정위2주）。대조조（ D조21이）위동기상규방법치료무효차거절고실용약급기타치료적돌발성롱환자，4조치료전은력급기본정황무현저차이（ P＞0.05）。비교각조은력회복급병발증정황。결과：치료완성후1월순음측은검사，치료조적전유、현효、유효、무효적례수분별위0、8、18、36례，총유효솔41.94％（26／62），우우대조조적9.52％（2／21），차이유통계학의의，치료후3조적PTA（ dB）균저우대조조。 A조화B조재료효상무통계학차이（ P＞0.05），A조、B조료효명현우우C조화D조（P＜0.05），재병발증발생솔상A조、B조화C조차이무통계학의의（P＞0.05）。결론：고실내주사지새미송보구성치료돌발성롱안전유효，유우A조치료차수다，급환자증가료경제부담급의료풍험，인차추천B조，즉2주4차적치료방안。
Objective:To observe and compare the efficacies of intratympanic dexamethasone perfusion in different course for sudden sensorineural hearing loss(SSNHL) after failure of initial therapy.Methods:Eighty-three patients (83 ears)with initial treatment failure of SSNHL were randomly allocated to three groups by intratympanic administration with 1 mL:5 mg in dose of 0.8 mL.Group A( n=22 ears) were treated once daily for consecutive 7 times (Therapy course: one week);group B(n=20 ears),twice a week for 4 times(Therapy course:two weeks);and group C(n=20 ears) once a week for 2 times(Therapy course: two weeks).Additional failure subjects(n=21 ears) who refused intratympanic dexamethasone perfusion or other medication were included as controls(group D).The previous 4 groups remained similarly in hearing levels before treatment,and compared concerning the recruitment of hearing and complications.Results:Examination by pure tone screening audiometry one month after the therapy showed that the total recovery ,significant effectiveness,effectiveness and invalid treatment were 0,8,18 and 36,respectively in the treatment group.The total effective rate was 41.94% (26/62), which was superior to the controls(9.52%;2/21),and the difference was significant.Lower pure-tone average(PTA,dB)was observed in the three treat-ment groups than the control group,yet group A was not significantly different from group B in efficacies(P>0.05).Both group A and B had better effects than group C and D(P<0.05),whereas the complications were not different among group A,B and C(P>0.05).Conclusion:Intratympanic dexametha-sone perfusion can be effective for SSNHL in patients with initial failure therapy .However,group A seem to require more treatment frequencies that is po-tentially to add economic burden and medical risks to the patient,thus our therapy course by 4 times in two weeks may be favorable protocol.