星状神经节阻滞用于慢性主观性耳鸣困扰的辅助干预效果及预测指标初析

Stellate Ganglion Block as an Adjunctive Intervention for Chronic Subjective Tinnitus:Efficacy and Predictive Indicators

【目的】探讨星状神经节阻滞(SGB)用于慢性主观性耳鸣困扰的辅助干预效果,及相应的预测指标,为SGB应用于耳鸣的临床干预累积经验。【方法】回顾因其他干预方案效果不理想而在中山大学附属第三医院耳鼻咽喉-头颈外科接受SGB干预的慢性主观性耳鸣患者资料。SGB干预前进行耳鸣残疾量表(THI)评估、纯音听阈测试、耳鸣响度评估,部分患者接受了睡眠质量(PSQI)评估。SGB干预后复测THI,以评价SGB的干预效果。随后,通过相关分析及线性回归方程探寻预测SGB干预效果的潜在指标。数据的统计分析采用SPSS 24.0进行,P<0.05表示存在统计学意义。【结果】至2023年04月,共有107名慢性主观性耳鸣患者接受了SGB干预,其中男性患者67名,女性患者40名,平均(45.32±11.40)周岁,耳鸣持续(20.32±24.64)月[16(12~20)]。有7名患者因个人原因中途退组,退组率6.54%,干预依从性良好。所有患者均未出现穿刺部位感染、血肿、神经损伤、局麻药中毒等不良反应,安全性良好。SGB干预后,有77名患者的THI得分下降至36分及以下,剩余的患者中有12名的THI得分下降幅度达到10分及以上,有效率为89%;配对样本t检验显示,SGB干预前后的THI得分有显著的统计学差异(t=15.575,P<0.001),干预效果良好。皮尔逊相关分析显示,干预前的THI得分和耳鸣主观响度与THI的改善水平呈显著的正相关关系(P<0.05);进一步的逐步线性回归分析发现,“干预前THI得分”具有显著的统计学意义(P<0.001),回归系数为0.308,预测了THI改善水平的17.4%。【结论】SGB干预慢性主观性耳鸣困扰的短期效果良好、安全性高,可用于常规干预方案不理想时(尤其是THI得分较高患者)的补充方案,但后续研究需要明确长期疗效及内在机制,为SGB应用于主观性耳鸣的干预奠定更为扎实的理论基础。

By April 2023,a total of 107 patients with chronic subjective tinnitus had undergone SGB intervention,includ⁃ing 67 male and 40 female,with a mean age of(45.32±11.40)years old and an average tinnitus history of(20.32±24.64)months[16(12~20)].Only 7 patients(6.54%)quitted the intervention for personal reasons,which demonstrated good compliance with the intervention.No patients experienced adverse reactions such as infection at the injection site,hemato⁃ma,nerve injury,local anesthetic intoxication and so on,which revealed good safety.After SGB intervention,THI scores decreased to below 36 points in 77 patients and decrease by 10 points or more in 12 of the remaining patients,with a total effective rate of 89%.A paired sample t-test showed a significant difference in THI scores before and after SGB interven⁃tion(t=15.575,P<0.001),indicating good improvement.Pearson correlation analysis suggested that pre-intervention THI scores and subjective tinnitus loudness were significantly positively correlated with the improvement level of THI scores(P<0.05).Further stepwise linear regression analysis found that"pre-intervention THI scores"had statistical significance(P<0.001),with a regression coefficient of 0.308,predicting a 17.4%improvement level in THI scores.【Conclusions】Due to its good and safe short-term effects,SGB intervention can be used as a supplementary option for chronic subjective tin⁃nitus when other interventions are not ideal,especially for patients with higher THI scores.However,further research is needed to clarify the long-term efficacy and underlying mechanisms,in order to establish a more solid theoretical basis for SGB intervention in the treatment of subjective tinnitus.