鼓室内激素注射的不良反应分析及应对措施探讨

Observation and prevention measures against adverse reaction to intratympanic corticosteroid injections

目的:分析鼓室内注射发生的不良反应,了解其临床特点及发生率,比较麻醉方法改良及甲泼尼龙注射剂配比改进后不良反应的发生情况。方法:回顾性分析712例(1 928次)鼓室内注射的患者资料,探讨其不良反应的整体情况及分类,年龄、性别、注射频次对不良反应发生的影响。并根据前期临床特点,改良麻醉方法及甲泼尼龙注射剂配比,观察不良反应的发生情况。结果:发生不良反应总76例,占所有注射病例的10.67%(76/712),其中重度不良反应4例(其中鼓膜穿孔2例),轻度不良反应62例,激素相关不良反应10例。不良反应发生与年龄性别及频次无相关性。改良麻醉方法后,眩晕发生率降低(改良前为7.0%,改良后为1.6%,P<0.05);甲泼尼龙联合利多卡因注射比甲泼尼龙注射疼痛率下降(甲泼尼龙为11%,甲加利为2.2%,P<0.05)。结论:鼓室内注射不良反应发生率低,是一项总体安全的治疗手段。麻醉药升温法及改变甲泼尼龙注射剂配比进一步减少眩晕及疼痛的发生。

Objective：To investigate clinical characteristic and incidence of the adverse reaction to tympanic injection.The incidence rates of adverse reaction were also compared after improvement of anesthetic method and changed ratio of methylprednisolone.Method：A retrospective analysis of 712 cases（1 928 injections）of receiving injection in a medical center,to explore the overall and classified adverse reactions,as well as effects of age and gender and frequency on adverse reactions.According to the clinical characteristics of the early stage,the incidence of adverse reaction was observed after the application of anesthesia warming method and the change of methylprednisolone ratio.Result：Adverse reaction was found in 76 cases which included 62 cases of mild reactions,4 cases of severe reactions and 10 cases of glucocorticoid-related reactions.Overall,10.67% of patients had adverse reactions.There was no correlation between adverse reactions and age,gender or frequency.The incidence of vertigo was decreased after the application of improved anesthesia（P〈0.05）.The incidence of pain of joint methylprednisolone-and-lidocaine injection was lower than that of methylprednisolone injection（P〈0.05）.Conclusion：Intratympanic injection is a safe treatment,to some extent,although there is low incidence of adverse effects of it.At the same time,anesthetic warming method and changing the ratio of methylprednisolone can further reduce the incidence of vertigo and pain.