医学论文-梅尼埃病手术治疗疗效观察.docVIP

医学论文-梅尼埃病手术治疗疗效观察 【摘要】? 目的：评估顽固性梅尼埃病患者采用内淋巴囊减压手术或 Meniett 治疗的疗效，并介绍处置体会和经验。方法： 17 例顽固性梅尼埃病患者中 9 例采用内淋巴囊减压手术，8 例在中耳植管后采用 Meniett 治疗。结果：内淋巴囊减压手术 治疗组和 Meniett 脉冲治疗组均各有 5 例患者疗效为 A 级（完全控制），完全控制率为分别为 55.5% 和62.5%。结论：内淋巴囊减压术与 Meniett 脉冲治疗的疗效无显著性差异，Meniett 脉冲治疗可以作为顽固性梅尼埃病的首选治疗方案。 【关键词】? 梅尼埃病；内淋巴囊减压；Meniett ??? 〔Abstract〕??? Objective???? To? measure? the? curative? effect? of? endolymphatic? sac? decompression? operation? and? Meniett? device? treatment? separately? in? patients? with? intractable? Menieres? Disease.? Nursing? experience? was? also? introduced.??? Methods???? 9? patients? in? 17? intractable? Menieres? Disease? patients? received? endolymphatic? sac? decompression? operation.? 8? patients? received? Meniett? device? therapy? after? placement? of? a? tympanostomy? tube.?? Results???? There? were? 5? patients? who? acquired? class? A? curative? effect? (complete? control)? in? endolymphatic? sac? decompression? group? and? Meniett? device? group? separately.? Complete? control? rate? was? 55.5%? and? 62.5%.???? Conclusion???? There? is? no? significant? difference? between? endolymphatic? sac? decompression? and? Meniett? device treatment? sac? in? curative? effect.? Meniett? device? treatment? can? be? the? first? choice? for? the? patients? with? intractable Menieres? disease. ??? 〔Key? Words〕??? Menieres? disease;? Endolymphatic? sac? decompression;? Meniett ??? 梅尼埃病是一原因不明的、以膜迷路积水为主要病理特征的内耳病，临床表现为反复发作性眩晕、感应神经性聋、耳鸣、可有耳闷胀感。目前主要采用镇静剂、抗眩晕药、脱水剂、血管扩张剂等药物保守治疗，然而保守治疗的疗效并不肯定，有约 30% 患者的眩晕发作对药物保守治疗无效。对于这些严重的的患者过去主要采用内淋巴囊减压、迷路切除术、前庭神经切断术等手术，近年来国外采用中耳置管后再通过 Meniett 等仪器给中耳间歇性加压的方法治疗梅尼埃病，取得了良好的效果[1，2]，我科自 2002 年以来采用手术治疗梅尼埃病 9 例，采用Meniett 治疗 8 例，现将结果及护理体会报道如下。 ??? 1??? 资料与方法 ??? 1.1??? 临床资料??? 对已排除蜗后病变、确诊为美尼尔病，并经 6 个月一般药物治疗（低盐饮食、血管扩张药、利尿药）无效的顽固、难治患者作为研究对象，我科 2002 年以来共收治保守治疗无效或效果不佳的顽固性梅尼埃病 17 例，其中男性 7 例，女性 10 例，年龄 23~62 岁，病程 1~6 年，平均 1.6 年。 ??? 1.2??? 方法??? 其中 9 例采用内淋巴囊减压手术治疗，8 例在中耳植管后采用 Meniett（Medtronic Xomed 公司生产）低压脉冲治疗。术前常规行电反应电测听检查、甘油试验、冷热试验、耳蜗电图、声导抗等检查，给每位患者建立病情报告卡并