鼻咽癌放疗后听力下降的辨证施护

Nursing in differentiation of hearing loss after radiotherapy

目的：观察鼻咽癌（nasopharyngcal carcinoma,NPC）放射治疗后听力下降（Postradiotherapy hearing loss PHL） 的辨证护理效果.方法：对60例NPC放疗后PHL患者,采用综合治疗,中医辨证施护.口服中药,活血化瘀,改善内耳循环.局部抗炎、疏通耳咽管,维生素营养内耳神经.心理治疗及康复护理.结果：所有患者治疗前均有耳呜、耳闷塞感、听力下降等症状.经综合治疗和渐进式康复护理后,耳呜消失38（63.33%）,好转14（23.33%）,无效8（13.33%）,总有效率86.67%;耳闷塞感消失49（81.67%）,好转9（15.00%）,无效2（3.33%）,总有效率96.67%;气导听闽均值从治疗前（36.3±4.5）dB HL提高到治疗后的（27.5±2.9）BHL,差异具有显著性（P〈0.01）.结论：分析NPC放疗后PHL的易患因素,有针对性地采取对症治疗和辩证施护,对提高NPC患者的生存质量具有重要意义.

Objective： To report authors experiences in treating and nursing of hearing loss in patients with nasopharyngeal carcinoma after radiotherapy, to improve understanding of its cause and identify effective nursing methods. Methods： Sixty three cases of postradiotherapy （PHL） in patients with NPC after radiotherapy were reviewed. Nursing included use of systemic and local vasodilators and steroids, supplemented by frequent debridement of the nasal and nasopharyngeal cavities and nursing of nasal and sinus diseases. Results： Prior to treatments and nursing, all patients reposed hearing impairment, tinnitus and fullness or pressure in the ear. Following systemic and local nursing,tinnitus completely resolved or improved in 86.67% of the ears. Fullness disappeared or improved in 96.67% of the ears. The mean pure-tone threshold over 0.5.1 and 2 kHz improved from （36.3 ±4.5） dB HL before treatment to （27.5± 2.9）dB HL after treatment and nursing. There was no otorrhea or permanent scarring in the Eustachian tube. Conclusion： Targeted treatment of PHL following radiotherapy based upon analysis of individual etiologies in patients with NPC can be quite effective and can significantly improve the life quality in these patients.