妊娠期突发性聋发病特点及疗效分析
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摘要
目的:探讨妊娠期突发性聋患者发病特点及疗效分析。方法:通过回顾性研究2015年8月1日至2018年6月30日收治的88例妊娠期突发性聋患者(包括门诊和入院患者)纳入实验组,根据2015年突发性聋诊疗指南,分为平坦型26例,全聋型62例,发病到就诊时间小于15 d,排除激素使用禁忌证,同时给予口服激素和鼓室注射,患者治疗后1、2、4周及3个月纯音测听结果进行疗效分析。并选择同期住院治疗的88例突发性聋患者进入对照组,平坦型26例,全聋型62例为对照(女性,排除妊娠)。结果:实验组以平坦型和全聋型最为常见,其中妊娠中期30例,后期58例,总有效率为39.77%(35/88)。妊娠全聋型治疗痊愈率为0(0/62),显效率为14.52%(9/62),有效率为24.19%(15/62);妊娠平坦型治疗痊愈率为0(0/26),显效率为19.23%(5/26),有效率为23.08%(6/26)。对照组全聋型痊愈率为6.45%(4/62),显效率为27.42%(17/62),有效率为38.71%(24/62)。对照组平坦型痊愈率为7.69%(2/26),显效率为34.62%(9/26),有效率为38.46%(10/26)。对照组总有效率为75%(66/88)。实验组和对照组总有效率相比,差异有统计学意义(P<0.05)。实验组全聋型、平坦型分别与对照组全聋型、平坦型相比,差异有统计学意义(P<0.05)。所有患者婴幼儿出生时评分均正常,随访3个月均健康。结论:妊娠突发性聋以全聋型最为常见,其次为平坦型,即妊娠期发病时听力损失较重,其治疗显效率、有效率均较普通突发性聋效果差,但仍需要进一步加大样本量;口服激素联合鼓室注射是一种安全的治疗方法。
Objective:To investigate the characteristics and treatment outcome of patients during pregnancy with sudden deafness.Methods:A retrospective study was conducted on 88 cases of sudden deafness during pregnancy who were admitted from August 1,2015 to June 30,2018(including outpatients and hospitalized patients). According to the guidelines for diagnosis and treatment of sudden deafness in 2015,there were 26 cases of flat type and 62 cases of total deafness. For these cases,the time from onset to visit was less than 15 days,and those with contraindications to hormones were excluded from the study. Oral hormone and intratympanic injection were then given at the same time. The results of pure tone audiometry at 1,2,and 4 weeks and 3 months after treatment were analyzed for curative effect analysis. Another 88 patients with sudden deafness who were hospitalized in the same period were selected as control group,consisting of 26 cases of flat type and 62 cases of total deafness(female,no pregnancy). Results:Flat type and total deafness are the most common types in the experimental group,including 30 cases in the second trimester of pregnancy and 58 cases in the third trimester. In this group,the overall response rate was 39.77%(35/88). And the cure rate,marked response rate,and response rate of total deafness were 0%(0/62),14.52%(9/62),and 24.19%(15/62),respectively,while the corresponding rates of flat type were 0%(0/26),19.23%(5/26),and 23.08%(6/26),respectively.Regarding the control group,the overall response rate,marked response rate,and response rate of total deafness were 6.45%(4/62),27.42%(17/62),and 38.71%(24/62),respectively. And the corresponding rates of flat type in the control group were7.69%(2/26),34.62%(9/26),and 38.46%(10/26),respectively.The overall response rate was 75%(66/88)in the control group.There was a significant difference between the experimental group and the control group in terms of the overall response rate(P<0.05). There were also significant differences with respect to the subjects of total deafness and flat type between these two groups(P<0.05). All infants' Apgar scores were normal at birth and they were all healthy during 3 months of follow-up. Conclusion:Total deafness is the most common type of sudden deafness in pregnancy,followed by flat type,with severe hearing loss during pregnancy.And the marked response rate and response rate are worse than those of common sudden deafness,but the sample size still needs to be further increased. Altogether,oral hormone combined with intratympanic injection is a safe treatment.
Objective:To investigate the characteristics and treatment outcome of patients during pregnancy with sudden deafness.Methods:A retrospective study was conducted on 88 cases of sudden deafness during pregnancy who were admitted from August 1,2015 to June 30,2018(including outpatients and hospitalized patients). According to the guidelines for diagnosis and treatment of sudden deafness in 2015,there were 26 cases of flat type and 62 cases of total deafness. For these cases,the time from onset to visit was less than 15 days,and those with contraindications to hormones were excluded from the study. Oral hormone and intratympanic injection were then given at the same time. The results of pure tone audiometry at 1,2,and 4 weeks and 3 months after treatment were analyzed for curative effect analysis. Another 88 patients with sudden deafness who were hospitalized in the same period were selected as control group,consisting of 26 cases of flat type and 62 cases of total deafness(female,no pregnancy). Results:Flat type and total deafness are the most common types in the experimental group,including 30 cases in the second trimester of pregnancy and 58 cases in the third trimester. In this group,the overall response rate was 39.77%(35/88). And the cure rate,marked response rate,and response rate of total deafness were 0%(0/62),14.52%(9/62),and 24.19%(15/62),respectively,while the corresponding rates of flat type were 0%(0/26),19.23%(5/26),and 23.08%(6/26),respectively.Regarding the control group,the overall response rate,marked response rate,and response rate of total deafness were 6.45%(4/62),27.42%(17/62),and 38.71%(24/62),respectively. And the corresponding rates of flat type in the control group were7.69%(2/26),34.62%(9/26),and 38.46%(10/26),respectively.The overall response rate was 75%(66/88)in the control group.There was a significant difference between the experimental group and the control group in terms of the overall response rate(P<0.05). There were also significant differences with respect to the subjects of total deafness and flat type between these two groups(P<0.05). All infants' Apgar scores were normal at birth and they were all healthy during 3 months of follow-up. Conclusion:Total deafness is the most common type of sudden deafness in pregnancy,followed by flat type,with severe hearing loss during pregnancy.And the marked response rate and response rate are worse than those of common sudden deafness,but the sample size still needs to be further increased. Altogether,oral hormone combined with intratympanic injection is a safe treatment.
引文
[1]中华耳鼻咽喉头颈外科杂志编辑委员会,中华医学会耳鼻咽喉头颈外科分会.突发性聋诊断和治疗指南(2015)[J].中华耳鼻咽喉头颈外科杂志,2015,50(6):443-447.
[2] Merchant SN,Durand ML,Adams JC. Sudden deafness:is it viral?[J]. ORL J Otorhinolaryngol Relat Spec,2008,70(1):52-60.
[3]唐俊翔,刘博.内淋巴积水与突发性聋关系的研究现状[J].中华耳鼻咽喉头颈外科杂志,2010,45(4):345-347.
[4]张姝,高晶.突聋发病机制的研究进展[J].听力学及语言疾病杂志,2012,20(1):60-63.
[5]田勇泉.耳鼻咽喉头颈外科学[M]. 8版.北京:人民卫生出版社,2013:354-357.
[6] Sennaroglu G,Belgin E. Audiological findings in pregnancy[J]. J Laryngol Otol,2001,115(8):617-621.
[7]曾祥丽,何建成,李鹏,等.妊娠期突发性感音神经性聋21例报道[J].中华耳科学杂志,2014,12(2):207-210.
[8]张庆.妊娠合并神经性耳聋7例的临床诊治[J].神经损伤与功能重建,2015,10(4):322-324.
[9]周长明,郑茜玲,杨川,等. 176例突发性耳聋患者的临床特征分析[J].中国听力语言康复科学杂志,2017,15(2):111-114.
[10] Rui JL,Krall R,Brian D,et al. Systematic review and meta-analysis of the risk factors for sudden sensorineural hearing loss in adults[J]. Laryngoscope,2012,122(3):624-635.
[11] Koo M,Hwang JH. Risk of sudden sensorineural hearing loss in patients with common preexisting sensorineural hearing impairment:a population-based study in taiwan[J]. PLoS One,2015,10(3):e0121190.
[12] Chang IJ,Kang CJ,Chen YY,et al. The relationship between serum lipids and sudden sensorineural hearing loss:a systematic review and meta-analysis[J]. PLoS One,2015,10(4):e0121025.
[13] Lionello M,Staffieri C,Breda S,et al. Uni-and multivariate models for investigating potential prognostic factors in idiopathic sudden sensorineural hearing loss[J]. Eur Arch Otorhinolaryngol,2015,272(8):1899-1906.
[14] Lee JS,Kim DH,Lee HJ,et al. Lipid profiles and obesity as potential risk factors of sudden sensorineural hearing loss[J]. PLoS One,2015,10(4):e0122496.
[15] Ciorba A,Hatzopoulos S,Bianchini C,et al. Idiopathic sudden sensorineural hearing loss:cardiovascular risk factors do not influence hearing threshold recovery[J]. Acta Otorhinolaryngol Ital,2015,35(2):103-109.
[16]黄帅,漆洪波.妊娠期易栓症的筛查[J].实用妇产科杂志,2009,25(3):138-140.
[17]贺芳,陈敦金.易栓症与不良妊娠结局的病理改变[J].中华产科急救电子杂志,2014,3(3):193-195.
[18] Pierangeli SS,Leader B,Barilaro G,et al. Acquired and inherited thrombophilia disorders in pregnancy[J]. Obstet Gynecol Clin North Am,2011,38(2):271-295.
[19]戴静,彭新,宋丽洁,等.突发性聋患者血液易栓症结果分析[J].中华耳科学杂志,2012,10(3):345-348.
[20]霍记平,曲圣慧,赵志刚. 2014年美国FDA颁布的妊娠和哺乳期用药信息标签最终规则介绍[J].药品评价,2015,12(6):13-19.
[21]张川,张伶俐,王晓东,等.全球妊娠期用药危险性分级系统的比较分析[J].中国药学杂志,2016,51(3):234-238.
[22]马冉阳,于红,汪欣,等.高压氧治疗突发性耳聋效果评价的Meta分析[J].吉林大学学报(医学版),2017,43(2):298-305.
[23]刘青乐,郑成刚.基础安全与操作规范并重——《高压氧临床应用技术规范》标准解读[J].中国卫生标准管理,2013,4(6):37-44.
[24]高占梅,宋扬,刘华,等.甲泼尼龙与地塞米松治疗突发性耳聋疗效比较的Meta分析[J].首都医科大学学报,2018,39(2):265-271.
[25]韦一,王德乐,王韶鉴,等.地塞米松与甲泼尼龙治疗突发性耳聋的临床疗效对比[J].中国全科医学,2014,17(27):3194-3196.
[26]王秋菊.激素作用机制与其在内耳病中的应用[J].中国医学文摘(耳鼻咽喉科学),2014,29(5):260-264.
[27]李谦华,戴冽. 2016年英国风湿病学会和英国风湿病卫生专业人员协会妊娠期和哺乳期处方用药指南解读——第一部分经典抗风湿药生物制剂和糖皮质激素[J].中国实用妇科与产科杂志,2016,32(10):924-928.
[28]卢胜军,石冰,廖礼姝,等.体外腭发育过程中地塞米松对腭中嵴上转归的影响[A].中华口腔医学会口腔颌面外科专业委员会唇腭裂学组.第七届全国唇腭裂学术会议论文集[C].中华口腔医学会口腔颌面外科专业委员会唇腭裂学组,2009:1.
[29]李淼.地塞米松磷酸钠导致斑马鱼颅面部发育异常的研究[D].武汉:华中科技大学,2009.
[30]曹祖威,岳凤娟,蔡文伟,等.鼓室注射类固醇激素为初始疗法治疗突发性聋文献的Meta分析[J].听力学及言语疾病杂志,2015,23(6):643-645.
[31]屈永涛,张慧平,陈红耀,等.鼓室内联合全身应用糖皮质激素治疗全聋型突发性聋[J].中华耳科学杂志,2016,14(3):388-391.
[32]申迹,项锦银.早期鼓室注射联合全身应用糖皮质激素对突发性耳聋的疗效探讨[J].重庆医学,2017,46(6):789-791.
[2] Merchant SN,Durand ML,Adams JC. Sudden deafness:is it viral?[J]. ORL J Otorhinolaryngol Relat Spec,2008,70(1):52-60.
[3]唐俊翔,刘博.内淋巴积水与突发性聋关系的研究现状[J].中华耳鼻咽喉头颈外科杂志,2010,45(4):345-347.
[4]张姝,高晶.突聋发病机制的研究进展[J].听力学及语言疾病杂志,2012,20(1):60-63.
[5]田勇泉.耳鼻咽喉头颈外科学[M]. 8版.北京:人民卫生出版社,2013:354-357.
[6] Sennaroglu G,Belgin E. Audiological findings in pregnancy[J]. J Laryngol Otol,2001,115(8):617-621.
[7]曾祥丽,何建成,李鹏,等.妊娠期突发性感音神经性聋21例报道[J].中华耳科学杂志,2014,12(2):207-210.
[8]张庆.妊娠合并神经性耳聋7例的临床诊治[J].神经损伤与功能重建,2015,10(4):322-324.
[9]周长明,郑茜玲,杨川,等. 176例突发性耳聋患者的临床特征分析[J].中国听力语言康复科学杂志,2017,15(2):111-114.
[10] Rui JL,Krall R,Brian D,et al. Systematic review and meta-analysis of the risk factors for sudden sensorineural hearing loss in adults[J]. Laryngoscope,2012,122(3):624-635.
[11] Koo M,Hwang JH. Risk of sudden sensorineural hearing loss in patients with common preexisting sensorineural hearing impairment:a population-based study in taiwan[J]. PLoS One,2015,10(3):e0121190.
[12] Chang IJ,Kang CJ,Chen YY,et al. The relationship between serum lipids and sudden sensorineural hearing loss:a systematic review and meta-analysis[J]. PLoS One,2015,10(4):e0121025.
[13] Lionello M,Staffieri C,Breda S,et al. Uni-and multivariate models for investigating potential prognostic factors in idiopathic sudden sensorineural hearing loss[J]. Eur Arch Otorhinolaryngol,2015,272(8):1899-1906.
[14] Lee JS,Kim DH,Lee HJ,et al. Lipid profiles and obesity as potential risk factors of sudden sensorineural hearing loss[J]. PLoS One,2015,10(4):e0122496.
[15] Ciorba A,Hatzopoulos S,Bianchini C,et al. Idiopathic sudden sensorineural hearing loss:cardiovascular risk factors do not influence hearing threshold recovery[J]. Acta Otorhinolaryngol Ital,2015,35(2):103-109.
[16]黄帅,漆洪波.妊娠期易栓症的筛查[J].实用妇产科杂志,2009,25(3):138-140.
[17]贺芳,陈敦金.易栓症与不良妊娠结局的病理改变[J].中华产科急救电子杂志,2014,3(3):193-195.
[18] Pierangeli SS,Leader B,Barilaro G,et al. Acquired and inherited thrombophilia disorders in pregnancy[J]. Obstet Gynecol Clin North Am,2011,38(2):271-295.
[19]戴静,彭新,宋丽洁,等.突发性聋患者血液易栓症结果分析[J].中华耳科学杂志,2012,10(3):345-348.
[20]霍记平,曲圣慧,赵志刚. 2014年美国FDA颁布的妊娠和哺乳期用药信息标签最终规则介绍[J].药品评价,2015,12(6):13-19.
[21]张川,张伶俐,王晓东,等.全球妊娠期用药危险性分级系统的比较分析[J].中国药学杂志,2016,51(3):234-238.
[22]马冉阳,于红,汪欣,等.高压氧治疗突发性耳聋效果评价的Meta分析[J].吉林大学学报(医学版),2017,43(2):298-305.
[23]刘青乐,郑成刚.基础安全与操作规范并重——《高压氧临床应用技术规范》标准解读[J].中国卫生标准管理,2013,4(6):37-44.
[24]高占梅,宋扬,刘华,等.甲泼尼龙与地塞米松治疗突发性耳聋疗效比较的Meta分析[J].首都医科大学学报,2018,39(2):265-271.
[25]韦一,王德乐,王韶鉴,等.地塞米松与甲泼尼龙治疗突发性耳聋的临床疗效对比[J].中国全科医学,2014,17(27):3194-3196.
[26]王秋菊.激素作用机制与其在内耳病中的应用[J].中国医学文摘(耳鼻咽喉科学),2014,29(5):260-264.
[27]李谦华,戴冽. 2016年英国风湿病学会和英国风湿病卫生专业人员协会妊娠期和哺乳期处方用药指南解读——第一部分经典抗风湿药生物制剂和糖皮质激素[J].中国实用妇科与产科杂志,2016,32(10):924-928.
[28]卢胜军,石冰,廖礼姝,等.体外腭发育过程中地塞米松对腭中嵴上转归的影响[A].中华口腔医学会口腔颌面外科专业委员会唇腭裂学组.第七届全国唇腭裂学术会议论文集[C].中华口腔医学会口腔颌面外科专业委员会唇腭裂学组,2009:1.
[29]李淼.地塞米松磷酸钠导致斑马鱼颅面部发育异常的研究[D].武汉:华中科技大学,2009.
[30]曹祖威,岳凤娟,蔡文伟,等.鼓室注射类固醇激素为初始疗法治疗突发性聋文献的Meta分析[J].听力学及言语疾病杂志,2015,23(6):643-645.
[31]屈永涛,张慧平,陈红耀,等.鼓室内联合全身应用糖皮质激素治疗全聋型突发性聋[J].中华耳科学杂志,2016,14(3):388-391.
[32]申迹,项锦银.早期鼓室注射联合全身应用糖皮质激素对突发性耳聋的疗效探讨[J].重庆医学,2017,46(6):789-791.