本文選題：鼓室內灌注類固醇激素 + 類固醇激素��； 參考：《廣西醫(yī)科大學》2011年碩士論文

【摘要】：目的鼓室內灌注類固醇激素治療是目前可以用來替代全身系統(tǒng)性使用類固醇激素治療特發(fā)性聾的一種較有前途的治療方法。然而,不同的研究之間的結果不同。本文的目的是對鼓室內灌注類固醇激素與不同治療方法治療特發(fā)性耳聾的療效分析。方法檢索Medline和Embase數(shù)據(jù)庫,兩位分析員獨立評價文獻并提取數(shù)據(jù),采用Stata11.0軟件進行Meta分析。結果通過檢索策略檢索出142篇文獻,最后納入8個隨機對照試驗,其中4個試驗納入的是首次治療特發(fā)性耳聾患者,4個試驗納入的是經(jīng)全身系統(tǒng)性運用類固醇激素治療失敗后的患者。在首次治療的4個試驗中有2個試驗是鼓室內灌注類固醇激素與口服類固醇激素的療效對比,1個試驗是鼓室內灌注、鼓室內灌注加口服類固醇激素與口服類固醇激素三者的療效對比,而該試驗按作兩個試驗提取數(shù)據(jù),即鼓室內灌注類固醇激素對比口服類固醇激素和鼓室內灌注加口服類固醇激素對比口服類固醇激素,最后1個試驗是鼓室內灌注加口服類固醇激素與口服類固醇激素的療效對比。在鼓室內灌注類固醇激素與口服類固醇激素首次治療療效對比的3個試驗中,分析結果顯示前者稍優(yōu)于后者,但無顯著性統(tǒng)計學差異(RR=1.22,95% CI 0.98至1.52,p=0.071)；在經(jīng)全身系統(tǒng)性使用類固醇激素治療失敗后使用鼓室內灌注類固醇激素與對照組(有的為除激素外的其他常規(guī)治療對照,有的為安慰劑對照而有的以不再作進一步的處理作為對照)的4個隨機對照試驗的分析結果顯示,實驗組明顯優(yōu)于對照組并且有顯著的統(tǒng)計學差異(RR=8.73,95% CI為2.46至30.92,p=0.001)。然而在2個對比鼓室內灌注加口服類固醇激素與口服類固醇激素的療效的試驗中,由于存在顯著的異質性(χ2=4.45,p=0.035,12=77.5%),故未進行Meta分析。此外,在全部8個試驗中有243例接受了鼓室內灌注處理,但只有2例發(fā)生了鼓膜穿孔,經(jīng)修補后均能治愈。結論對于不能耐受全身系統(tǒng)性使用類固醇激素的患者,鼓室內灌注類固醇激素是一個很好的替代方法,即使是經(jīng)過全身系統(tǒng)性使用類固醇激素失敗后的患者,鼓室內灌注類固醇激素仍是一個不錯的挽救性治療方法,并且這一操作在臨床上是相對安全的。
[Abstract]:Objective Intratympanic steroid therapy is a promising alternative to systemic steroid hormone therapy for idiopathic deafness. However, the results vary from study to study. The purpose of this paper is to analyze the therapeutic effect of intratympanic infusion of steroid hormone and different treatment methods on idiopathic deafness. Methods Medline and Embase databases were searched. The two analysts independently evaluated the literature and extracted the data. Stata11.0 software was used for Meta analysis. Results 142 articles were retrieved by search strategy, and were included in 8 randomized controlled trials. Four of the trials involved the first treatment of idiopathic deafness and four included patients who had failed in systemic steroid therapy. Two of the first four trials were compared with oral steroid hormone infusion in the tympanic cavity, and one was in the tympanic cavity. The effects of intratympanic perfusion plus oral steroid hormone and oral steroid hormone were compared, and the data were extracted from two trials. That is, intratympanic infusion of steroid hormone versus oral steroid hormone and intratympanic perfusion plus oral steroid hormone versus oral steroid hormone, The final trial was a comparison of the effects of intratympanic perfusion with oral steroid hormones and oral steroid hormones. In three trials in which intratympanic steroids were infused with oral steroids for the first time, the results showed that the former was slightly better than the latter. However, there was no significant statistical difference between RRX 1.22 95% CI 0.98 to 1.52p0.071%, and after systemic steroid hormone therapy failed, intratympanic instillation of steroid hormone was given to the control group (some of which were compared with those of the control group). The results of four randomized controlled trials with placebo control and no further treatment showed that the experimental group was significantly superior to the control group and had a significant statistical difference between 2.46 and 30.92p0.001of RRN 8.7395% CI. However, Meta analysis was not carried out in two tests comparing the effects of intratympanic perfusion with oral steroid hormones and oral steroid hormones because of the significant heterogeneity (蠂 ~ 24.45). In addition, 243 cases were treated with intratympanic perfusion in all 8 trials, but only 2 cases had tympanic membrane perforation, all of which could be cured after repair. Conclusion Intratympanic instillation of steroid hormone is a good alternative for patients who cannot tolerate systemic steroid hormone use, even after systemic steroid use failure. Intratympanic steroid infusion is still a good rescue therapy, and this procedure is relatively safe clinically.
【學位授予單位】：廣西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2011
【分類號】：R764.43

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