通窍汤辨治突发性耳聋60例临床观察

Clinical Observation of Tongqiao Decoction Treatment 60 Cases of Sudden Deafness

目的:探讨自拟通窍汤辨治突发性耳聋的临床疗效及对微循环障碍的影响。方法:将120例突发性耳聋随机按数字法分为对照组和观察组各60例。对照组采用前列地尔注射10μg/次,静脉滴注(iv gtt),1次/d;甲钴胺片,500μg口服,3次/d。观察组在对照组治疗的基础上加服通窍汤,并根据不同证型进行加减,1剂/d。两组疗程均为14 d。采用声阻抗及纯音测听测试患者纯音听阈值改变情况;检测患者治疗前后血流动力学指标;记录听力、耳鸣、眩晕、耳闷改善时间;采用放射免疫法测定检测治疗前、后血浆内皮素(ET)含量、血清一氧化氮(NO)水平的变化。结果:观察组轻、中度耳聋总有效率为95.15%,重度以上耳聋总有效率为84.2%,平均总有效率为91.66%,均优于对照组的77.5%,55.0%和70.0%(P<0.05);治疗后第7,14天两组纯音听阈值均较治疗前明显改善,观察组的改善优于对照组(P<0.01);治疗后两组血流动力学指标均明显改善,观察组纤维蛋白原(Fb)、低切变率下全血黏度(nbl)、高切变率下全血黏度(nbh)及血浆比黏度(np)的改善优于对照组(P<0.01);治疗后观察组ET低于对照组,NO水平高于对照组(P<0.01)。结论:在西医常规治疗的基础上加用通窍汤辨证治疗突发性耳聋,能减轻患者临床症状,提高听力,提高临床疗效,其作用机制可能与其降低患者血液黏度,增加内耳血流量,改善内耳微循环有关。

Objective： To investigate the clinical research and effects on microcirculation of self defense Tongqiao decoction to treatment with sudden deafness. Method： One hundred and twenty cases of patients with sudden deafness were randomly divided into control group （ n = 60） and observation group （n = 60）. Control group were treatmented with alprosiadil injection of 10 μg/times, intravenous infusion, 1 time each day; methylcobalamin tablets, 500 μg orally, 3 times/d. Observation group were treatmented with additional services Tongqiao decoction, and add or subtract according to different syndromes, 1 time each day. Treatment lasted 14 d. The changing circumstances of pure tone threshold were measured with acoustic impedance and pure tone audiometry. The hemodynamics were detected in patients before and after treatment. The improve time of hearing, tinnitus, vertigo, ear fullness were record. The levels of plasma endothelin （ET）, serum nitric oxide （NO） were treatmented with radioimmunoassay detected. Result： The total effective rate of mild to moderate hearing （95.15% vs 84.2% ） was higher than severe hearing. The average total effective rate of observation group （91.66% vs 77.5% ） were better than the control group （77.5% , 55.0% , and 70.0% ） （P 〈0.05） ; the pure tone hearing thresholds after 7 and 14 days were improved than before treatment. The observation group wereimpoved than the control group （P 〈0.01）. The hemodynamic parameters after treatment were significantly improved, The levels of fibrinogen （Fb） , low shear rate whole blood viscosity were improvement than the control group （P 〈0. 01 ）; The levels of ET and NO of observation group were higher than control group （P 〈0. 01 ）. Conclusion： Tongqiao soup dialectical treatment of sudden deafness can reduce clinical symptoms, improve listening skills, improve clinical efficacy. Its mechanism may be related to the decrease in patients with blood viscosity, increased inner ear blood flow, improve microcirculation inner ear