不同病程高频特发性耳鸣药物治疗初步研究

A preliminary study on pharmacological treatment of idiopathic high pitched subjective tinnitus of various durations

目的探讨不同病程高频主观特发性耳鸣药物治疗的地位、方案选择、效果,并作远期疗效随访。方法采用前瞻性随机对照的研究方法,219例耳鸣患者按病程分为急性期组、亚急性期组和慢性期组,每组患者随机抽取三种药物治疗方案(血栓通、血栓通+红花黄色素、血栓通+红花黄色素+地塞米松)中的一种进行治疗,疗程3周。采用刘蓬、李明耳鸣严重程度评估量表,分别在3个时间点进行疗效评估。以SPSS13.0统计软件进行数据处理。结果 1.至随访结束,219例患者痊愈15例(6.8%)、显效32例(14.6%)、有效84例(38.4%)、总有效131例(59.8%)、无效88例(40.2%);三组的痊愈率:急性期为18.6%(13/70),亚急性期为2.9%(2/68),慢性期为0%(0/81);三组的总有效率:急性期为68.6%(48/70),亚急性期为58.8%(40/68),慢性期为53.1%(43/81);2.三组的近、远期疗效比较:急性期组的近、远期痊愈率均优于亚急性期组和慢性期组,差异有统计学意义(P<0.01),亚急性期组和慢性期组的近、远期疗效分别比较,总有效率差异均无统计学意义(P>0.05);3.疗效随访情况:三组各自远、近期疗效比较,差异均无统计学意义(P>0.05);4.不同治疗方案比较:血栓通方案和联合用药方案比较,三组的总有效率差异在第1时间点均无统计学意义(P>0.05),在第2、3时间点均有统计学意义(P<0.05);含激素方案分别和血栓通方案及联合用药方案比较,三组的总有效率差异在3个时间点均有统计学意义(P<0.05)。结论药物治疗在不同病程耳鸣患者的治疗地位有所不同,急性期值得积极推荐,首选含激素的联合用药方案。亚急性期和慢性期等病程较长者,药物治疗效果差,可作为辅助治疗,但不应只局限于改善微循环的药物。就药物治疗效果来说不同病程组患者随访近、远期疗效稳定。

Objective To study the status of pharmacological treatment, its scheme selection, short-term and long-term effects in patients with high-pitched subjective idiopathic tinnitus of various durations. Methods A prospective, randomized and controlled study was carried out in 219 patients with acute, subacute or chronic tinnitus, grouped according to their tinnitus durations. Patients in each group were randomly selected to be treated with one of three drug schemes for 3 weeks. Treatment effects were evaluated at three time points using the Tinnitus Evaluation Questionnaire （TEQ, by Liu and Li）. The SPSS13.0 software was used for data analysis. Results At the end of follow-up, 15 patients （6.8%） showed com- plete recovery, 32 （14.6%） showed significant improvement, 84 （38.4%） showed some improvement and 88 （40.2%） showed no improvement. The rates of complete recovery were 18.6% （13/70） in the acute group, 2.9% （2/68） in the sub- acute group and 0% （0/81） in the chronic group. Total effectiveness rates in the acute, subacute and chronic groups were 68.6% （48/70）, 58.8% （40/68） and 53.1% （43/81）, respectively. Both short-term and long-term outcomes in the acute group were superior to those in the subacute and chronic groups, although there was no significant difference in the total effective- ness rate between the subacute and chronic groups, or between short-term and long-term outcomes among all groups. Be- tween the Xueshuantong and combination drug schemes, the total effectiveness rates among the three groups was differentat the 2nd and 3rd time points, but not at the 1st time point. However, results from the steroid scheme showed significant difference as compared with the other drug schemes at all three time points. Conclusions Pharmacological treatments have different roles in treating high-pitched subjective idiopathic tinnitus of different durations. In patients with acute tinnitus, drug therapies should be engaged aggressively, with a combined drug scheme containing steroid being preferred. Patients with subacute and chronic tinnitus appear to have a poor response to pharmacological treatments. Short-term and long-term effects of pharmacological treatments appear stable in patients with tinnitus, regardless of its duration.