半植入式微管跨膜控释给药治疗梅尼埃病的研究

Controlled drug delivery using semi-implantable microcatheter for treatment of Ménière′s disease

目的探讨半植入式微管跨膜控释给药对梅尼埃病的治疗效果。方法经临床确诊的6例梅尼埃病患者接受微管给药治疗(美国耳鼻喉学会标准)。患者年龄34～72岁,男性5例、女性1例;病程为9个月到20年,患耳的听力均为4级(听阈70 dB以上),术前6个月内平均每个月发作眩晕1～2次。在耳显微镜下向患者鼓室植入IntraEAR微管(美国Durect公司),微管的一端位于圆窗龛,另一端与体外控释泵连接,以50μl/h的速度释放庆大霉素工作液(2 mg/ml)。每天给药3 h,7～10 d后拨管结束治疗。结果治疗期间6例均未出现眩晕,但其中1例出现耳鸣增强。随访1～14个月,除1例失访外,其余5例在眩晕、听力及耳鸣方面都有不同程度的改善。5例中,3例发作性眩晕的程度较术前明显减轻;2例术后未发作眩晕。1例治疗期间耳鸣增强的至随访14个月时,耳鸣程度较术前明显减轻。1例复查前庭功能有改善。结论应用半植入式微管小剂量低流速跨圆窗膜控释给药能够有效控制或减轻梅尼埃病的眩晕,是治疗顽固性梅尼埃病的一种安全、有效的手段。

Objective To study the effect of controlled drug delivery using semi-implantable microcatheter for treatment of Meniere＇s disease. Methods Six patients diagnosed with Meniere＇s disease were treated with the microcatheter. The history of the patients was from 9 months to 20 years, and their hearing level was 4 （hearing threshold above 70 dB）. Half year before the treat- ment their vertigo attacked once or twice per month. IntraEARmicrocatheter was implanted in the patient＇s tympanum under otologic microscope. The tip of the catheter was placed in the round window niche, and the other end was connected with an osmotic pump, which delivering gentamycin （2 mg/ml） in 50 μl/h. The treatment was performed 3 hours every day and ended in 7-10 days. Results Till the end of the treatment, all of the 6 patients did not suffer from vertigo whereas tinnitus of one patient increased. One of the patients was lost to follow-up, the remaining 5 patients were followed up from 1 to 14 months. The symptoms of vertigo attacks were alleviated in 3 patients. Vertigo disappeared in 2 patients. Tinnitus of 1 patient, whose tinnitus increased during treatment, was apparently alleviated during follow-upwas apparently alleviated. The vestibular function was improved in 1 patient. Conclusion Using the semi-implantable microcatheter to treat Meniere＇s disease can control the vertigo attacks. It is a safe, effective treatment for Meniere＇s disease.