不同局部应用糖皮质激素方式在治疗难治性突发性聋的疗效观察

摘要

目的 观察不同局部糖皮质激素(Glucocorticoid,GC)方法治疗常规治疗无效的突发性聋患者的临床疗效.方法 回顾性分析2013年3月至2017年3月在南京鼓楼医院常规治疗至少1个疗程无效的难治性突发性聋的患者,共305例(305耳).根据患者治疗方案不同将病人分为治疗组(277耳)和对照组(D组,28耳),其中,治疗组分为鼓室灌注甲强龙联合静脉全身给药组(A组,216耳),耳后注射甲强龙联合静脉全身给药(B组,42耳),耳后注射组(C组,19耳).A组患者鼓室置管,每天鼓室灌注甲强龙20mg,并予银杏叶提取物注射液105mg、单唾液酸四己糖神经节苷脂钠40mg静脉滴注;B组每3天予患耳后乳突骨膜下注射甲强龙40mg治疗,共4次,联合静脉应用银杏叶提取物注射液105mg、单唾液酸四己糖神经节苷脂钠40mg;C组每3天予患耳后乳突鼓膜下注射甲强龙40mg治疗,共4次,并口服银杏叶片和甲钴胺.对照组为常规治疗失败后每天继续静脉给予银杏叶提取物注射液105mg、单唾液酸四己糖神经节苷脂钠40mg常规治疗.所有患者治疗结束后均口服银杏叶片和甲钴胺片12月.按照中华医学会突发性聋的疗效标准比较发病后第3个月末各组的听阈.结果 治疗组中ABC三组的有效率分别为35.2%、50%、42.1%,对照组有效率为7.14%,治疗组比对照组患者疗效显著(χ2=14.11,P=0.003),四组平均PTA改善分别为11.63⊥16.75dB、17.78⊥18.12dB、18.38⊥22.9dB、4.85⊥9.10dB,治疗组比对照组PTA改善值明显(t=2.75,P=0.043).发病至就诊时间为影响听力预后的重要因素,选取发病至就诊时间在3周以内的患者,鼓室置管灌注GC与耳后注射GC疗效相近(χ2=1.21,P=0.247).结论 不同方式局部应用GC治疗难治性突发性聋较继续常规治疗具有明显疗效,发病至就诊时间为听力预后的主要影响因素,鼓室灌注GC、耳后注射GC之间疗效无明显差异.由于本组耳后注射GC的病例资料明显少于鼓室内给药,有待于进一步增加病例数,以及多中心前瞻性随机对照研究.%Objective To report outcomes of various rescue glucocorticoid treatment regimens for refractory sud-den sensorineural hearing loss(SSNHL).Methods Three hundred and five cases(305 ears)of SSNHL that had failed more than 10 days of conventional therapy were divided into a study group(SG,277 ears)and a comparison group(CG,28 ears).Patients in the SG received glucocorticoids via a micro-catheter inserted into the tympanum qd for 10 consecu-tive days plus i.v.transfusion of gingko extracts and monosialotetrahexosylganglioside(group A,206 ears),4 doses of postaural injection of glucocorticoids every 3 days plus i.v.transfusion of gingko extracts and monosialotetrahexosylgan-glioside(group B,42 ears)or 4 does of postaural injection of glucocorticoids every three days plus oral (group C,19 ears).Patients in the CG received only i.v.transfusion of gingko extracts and monosialotetrahexosylganglioside.All pa-tients in both SG and CG were maintained on oral gingko extracts and vitamin B12 following rescue therapy and fol-lowed up for 3 months.Results The effective rate in the SG was significantly higher than in the CG (χ2=14.11,P=0.003).The average PTA improvement was 11.63⊥16.75 dB (Group A),17.78⊥18.12 dB (Group B) and 18.38⊥22.9dB(Group C)respectively for the SG,but only 4.85 dB for the CG(t=2.75,P=0.043).When treatment was started within 3 weeks post-disease onset,effective rates showed no statistically significant difference between intratympanic and postaural injection of glucocorticoids (P>0.05).Conclusion The rescue glucocorticoids injection treatments em-ployed in the SG in this study appear to be beneficial as compared to no rescue treatments.While the interval from dis-ease onset to therapy can affected treatment efficacy,when started within 3 weeks from disease onset,intratympanic glu-cocorticoid perfusion appears to be similarly effective as postauricular glucocorticoids injection only.