DANH GIA HIEU QU.\ CUA OXY CAO AP TRONG Dl£U TRI DIEC DQT NGpT
Vd Td Kiem. Oiu Lan Anh, Nguyen Thdnli Lgi, Nguyin Kim Phong, Nguyin Phuang Nam T 6 M TAT
Tinh hinh va muc dich nghien cihi: Trong cac phuang phap didu trj diec dot nggt (DDN), phtrong phip oxy cao ip (OXCA) da diroc i p dung nhigu noi tren thi gioi. 6 nuoc ta, diau tri DDN bing OXCA da co nghien ciiu Iham do tit nam 2003, buoc dau cho kit qui kha tjuan hem thu6c giin mach (TGM). Tuy nhien, d l dinh gii lai;
dung cua OXCA doi voi E)DN con nhilu vin dl can lim sang to. Vi thi, chiing t6i xiy dung v i men khai dl t^i niy nhim muc tiiu xic djnh ti le cai thien DDN do dilu tri bing OXCA va moi lien he giua viec dieu trj som hay muon vai kei qua dieu tri.
Thiet ke nghign cuii: Nghien ciiu ino ta liln cuu, so sinh doi chiing giiia hai nh6m dieu tri \ a nhdm chumg.
Doi tuwng - phutmg phap nghl§n cmi: 300 benh nhin DDN den kham va dilu trj tai benh vien TMH thinh ph6 HCM va Tmng tam OXCA tir thing 4/2007dlii thing 5/2009. Cic benh nhan niy sau 5 ngiy dilu tri Sutjc do lai thinh luc d6: N I U khSng cai thien, hoic cii thien < 10 dB se duoc chpn ngau nhien chia lam hai nhdm:
Nh6m chung tilp tuc dilu tri nhu cii (TGM + Corticoid); Nhom nghien cuu: Dilu tn nhu cu -i- OXCA.
Ket qua: Ti le cai thJen trieu chiing u tai nhom nghifin cuu la 93%, ti le c6 cii thien thinh luc la 82% (i6l 20.5%), ti le cai thi?n tliinh luc nhdm diec mpt tai la 80%, ti le cd cai thien thmh luc nhom diec n^ng la 88.7%, ti IS c6 cai thien thi'nh lyc ddi voi nhdm benh din khim trong tuin dau la 88 5%, cao han nhdm chiing c6 -$ nghia thong ke.
Kei luan: DDN sau 5 ngay dieu tri phic d l qui udc, nlu thinh luc khong cai thif n. hoac cai thien < 10 dB nen dup'c dieu tri OXCA ket hpp
ABSTRACT
ASSESSMENT OF HYPERBARIC OXYGEN IN THE THERAPY OF SUDDEN DEAFNESS
Vo Ta Kiem. Chu Lan Anh. Nguyen Thanh Loi, Nguyen Kim Phong, Nguyen Phuong Nam Situatioa and purposes of research: In the therapy of sudden deafness (DDN), hyperbaric oxygen method (OXCA) has been applied in many places in the world. In our counU7, therapy of DDN with OXCA had research, survey since 2003, initially obtained more satisfactory results than vasodilator (TGM). However, to evaluate the effect of OXCA for DDN, it remains many issues to clarify Therefore, we build and deploy this theme to identify the rate of sudden deafness improvement by therapy with OXCA and the relationship between sooner or later therapies with the results of therapy.
Research Design: Research describes funds, compares two groups of therapy and control group.
Subjects studied: 300 patients of DDN examined and hospitalized at HCM City ENT hospital and the Center for hyperbanc oxygen from 4/2007 to May 2009. These patients after 5 days of therapy were measured for hearing: If no improvement or improvement <10 dB will be selected randomly, divided into two groups: control group continued therapy as previously (Archbishop -i- corticoid); research group: undergo therapy like previous one + OXCA.
Results: The rate of tinnitus symptoms improvement in research group is 93%, the rate of improved hearing is 82% (20 5% is good), the rate of improved heanng in group of a deaf ear is 80%, rate of hearing improved in group of serious deafness is 88.7%, the rate of improved hearing for the group examined in the first week was 88.5%, higher than control group for statistical purpose.
Conclusioo: DDN after 5 days of conventional therapy regimen, if the hearing does not improve, or improve
<10 dB should be treated with combined OXCA.
D ^ T VAN DE
Diic dot ngot ^>DN) l i mpt cap ciiu Tai Mui Hpng khi thu6ng gap, l i mot benh chua bilt ro cin nguyen, du nguoi ta dua ra nhieu gii thuyet. Do d6, vin d l dilu tri gip kht5 khan, nhit Ii benh niy c6 khi tu khoi khong can dieu tri. Vi the, danh gii hieu qua cua mot phuang phap diSu trj nao d6i vai DDN cung rat khd. Chua cd phuang phip nio dugc khuyin khich la chic chin hieu qui cao trong dilu tri DDN. Cic phuong phap dilu tri hien nay dang dupe khuyen khich bao gdm: giin mach, khing dong, giam do nhdt cua miu, corticoids, vitamine.
an than, nghi ngoi.
Mot phuang phap dilu tri DDN dang dugc chd -^ la oxy cao ip (OXCA). Nguai la d i thu ap dyng OXCA trong dieu trj cin bgnh nay va da d^t ducrc kit qua nhit dinh 6 nudc ngoai cung nhu o trong nudc. Nhung ve hi?u qua cung nhu ca che tic dung ciia phuong phap con co nhilu tranh luin, v i dang dupe tilp tuc nghien cuu. Vi vay. chdng tdi xay dung va triln khai dl tii nay vdi mong mudn gdp phin dinh gii tic dyng ciia OXCA doi vdi DDN vo cin, muc tieu cua de tii:
Mgc tigu tong q u i t : Xic dinh ty le cii thi|n diic do dilu tri OXCA va mdi lien h? giira viSc dilu tri sdm hay mupn vdi ket qua dieu tri.
Muc tieu cu t h i :
- Xac djnh ty le cii thien DDN do dilu tri gian mach + corticoid.
- Xac dinh ty le cai thien DDN do dilu tri gian mach -t- corticoid -H OXCA - Xac dinh mdi lien quan giira viec dilu tri sdm hay muon vdi kit qui dilu tii.
B 6 I TirONG VA PHirONG PHAP NGHIEN CUtJ DOI T i r O N G NGHIEN CUtJ
Cac benh nhan bi DDN din khim va dilu tri tai khoa Tai Diu Mat Co benh vien Tai Mui Hpng Tp HCM va Trung tam OXCA - Trung tam Nhiel ddi Viet Nga tit thing 4/20O7 din 5/2009
!• Tieu c h u l n ebon bfnh:
Chpn n ^ u nhien 300 benh nhin DDN, kh6ng phin biet gidi tinh, nghl nghiep, tudi tir 16 din 60. Vdi cic tieu chi: Diic xay ra dot ngpt tir vai gio den vai ngay, diec tiep nhan mpt tai hoac hai tai, mil it nhit 30dB d ba tin s6, khong cd tiln sir benh ly tai ngoii, tai giiia.
2. Tieu c h u i n loai trir:
Chdng chi djnh vdi OXCA: Tran khi mang phdi tir phit, viem phdi, COPD, dong kinh, ting huylt i p , tii chdi dilu tri OXCA (chiing so buong kin).
PHL'OfNG PHAP NGHIEN ClTU 1. Thilt ke ngbien ciiu:
Nghien ciiu rod t i tiSn ciiu, so sanh ddi chung giiia 2 nhdm dieu tri:
- Thude gian mach (TGM) + corticoid - Oxy cao i p (OXCA) + TGM + corticoid 2. P h m m g phap chon mau
300 benh nhan DDN duac dieu tri tai benh vien TMH, sau 5 ngiy do lai thinh Iyc dd, neu thay khdng cii thien hoic cii thien nhd hon lOdB se dupe chpn nglu nhien chia lam hai nhdm:
Nhdm I : Tiep tuc dieu tri nhu cii (TGM -i- corticoid) Nhdm H: Tilp tuc dilu tri nhu cii (TGM + corticoid) -i- OXCA 3. Pbutmg tien nghien ciru
3.1 D I chan doan :
M i y do thinh lire va nhi lugng.
Xet nghiem thudng qui: cdng thiic mau, Het, X-quang phoi, Vss, cholesterol...
E.C.G ddi vdi ngudi cd tien sii tim mgch.
3.2. De dieu t r i :
a). Budng Oxy cao i p : Thdng nhit dijiig mot loai cho nhdm nghien cihi: Loai budng c i nhan do Trung Qudc san xuit, ki hieu NG900/IIIB
b) Oxy tinh khilt dung trong y te.
c) Su dung cic thuoc sau:
. Nootropyl (dung djch tiem truyen). Sibelium (vien) Smg.
. Solumedrol 40mg (dung dich pha liem). Prednisone (vien) Smg.
. Glucose (dung djch tiem tmyen) 5%. protase (\ien)90mg, neuvramin (vien).
4. Cac bu^c tbuc hien:
- Lam hd sa nhap vien, benh nhan duoc do thinh lye dd, nhi luong do, x^t nghiem miu (cong thiic miu, Vss), X-quang phdi ngay mrdc khi nh|p vien.
- Hoi kJ vl tiln sir tim mach, chin thuang tai (neu cd) - Do huylt ap. Khim Tai Miii Hpng, khim thin kinh
- Tiln hanh dilu tri theo phic do benh vien 5 ngiy —• Do thi'nh lyc dd kiem tra —* Chpn benh.
- Khi benh nhan nim trong tieu chuan chpn nghien ciiu, chdng tdi chia ngau nhien thinh 2 nhdm d l tiln hinh nghign Cliu dilu ^
4.1. Nhdm dieu t n bang TGM:
. Corticoid: TTnh maeh lieu cao, giim lieu din.
- Nootropyl; I2g TTM (pha + trong 250ni] Glucose 5%y^H 10"^^'' - Sibehum 5 mg Iv x 2 lan / ngiy
4.2. Nbdm dilu t n b i n g OXCA:
- Diing Ihudc nhu nhdm TGM.
- Dilu trj OXCA : Ap suit 2.5ATA x 60 phut/ngay x 10 ngiy.
+ Toa thuoc I tuan sau xuat vi^n (chung cho ca hai nhdm):
- Sibehum 5 mg Iv x 2 lin / ngay - Protase Iv x 3 lan / ngiy - Neuvramin Iv x2 lan / ngay
-I- Do lai thinh lyc dd va nh! lupng dd vao ngay thii 10 & 15.
-I- Lap phiSu thong ke
5. Dira vao ket q u i gjiia hai nhdm de so sanh theo cac chi tieu:
- Khach quan:
-H So sanh thinh lyc dd (TLD) d 3 tin so nghe kdm nhit.
-I- Dya vao cai thieii thi'nh Iyc dd sau dilu tri de dinh gia ket qua vdi cic miic dp:
• Tdt; thinh lyc dd eai thien > 30 dB
• Khi . thi'nh luc dd cii thien tir ID - 29 dB
• Kem : thinh lyc do cai thien < 10 dB, hoac nang thdm.
- Chii quan: Dya vao cac tri?u chiing co nang: 0 tai, chdng mat, budn ndn vdi cic miic dp:
• Tdt: Het khdng cdn tneu chiing
• Khi' Cac tri?u chiing con, nhung giim ro ret
• Kdm (khong cai thifn): Cac trieu chiing nhu cu hoac n^ng thfim 6. Phinmg phap xu* ly > a phan tich s i lifu
Su dung chuong trinh SPSS ver 16.0 de xu ly va phan tich:
• Tning binh vi dp lech chuin duoc dung de mo l i bien sd dinh luong.
• Kilm djnh x2 duoc su dung de so sanh ti 1? v i trung binh cua cic nhdra
• Ngu5ng 0,05 duoc chpn de loai bd gia thuyet khdng trong thdng kd.
KET QUA NGHIEN CUtl
Trong thai gian nghien ciiu tit 04/2007 den 05/2(K)9, chung toi thu Ihap dugc nhirng benh nhan thda cic tieu chi chpn b$nh:
- Nhdm OXCA: 150 trudng hpp - Nhdm TGM: 150 trudng hpp D^C DIEM MAU NGHIEN CUU 1. Tuoi
Bang 1. Phin bo tudi d 2 nhdm nghien cuu Tuoi
< 2 0 2 0 - 2 9 3 0 - 3 9 4 0 - 4 9 5 0 - 5 9 60 Tong Nho nhat Lon nhat Tnmg binh
Thuoc gian m^ch N 4 26 33 40 38 9 150
T y l 8 % 2.7 17.3 22.0 26.7 25.3 6.0 100.0 16 60 39.54 ±12.74
Oxy cao dp N 12 26 38 34 30 10 150
T y l ¥ % 8.0 17.3 25.3 22.7 20.0 6.7 100.0 16 60 41.72*11.97
T6ng N 16 52 71 74 68 19 300
T y l e % 5.3 17.3 23.7 24.7 22.7 6.3 100.0 16 60 40.63 112.39 (Z2 = 5.837, p = 0.322; F = 2.331, p = 0.128)
Nhan xet:
- Tudi trung binh giiia hai nhdm khdng cd sy khic bi?t.
- Nhdm tudi tap trung d liia tudi lao dpng.
2. Phan bo theo gidi tinh
Bang 2. Phan bd gidi tinh d 2 nhdm nghien ciiu Gidi tinh Tbuoc gian macb
N 1 Ty If %
Oxy cao ap N 1 Ty Ie %
Chung N 1 Ty I? %
.Nam NS Tong
72 78 150
48.0 52.0 100.0
84 66 150
56.0 44.0 100.0
156 144 300
52.0 48.0 100.0 Nhan x e t :
3. Ngbe nghiep
Z2 = 1.923.p = 0.166 ' Ti le nam nii tucmg ducmg nhau
- Phan bd ti le nam nir giira hai nhdm khdng cd sy khic biet.
Nglie Dghiep CBCNV Cong nhan
Khac Tong
Bang 3 Phan bo theo nghe nghiep a 2 nh6m nghien cliu Thuoc gian mach
N 72 71 7 150
T y l 5 % 48.0 47.3 4.7 100.0
Oxy cao ap N 69 66 15 150
Ty If % 46.0 44.0 10.0 lOO.O
Chung N 141 137 22 300
Tylf % 47.0 45.7 7.3 100.0 X2 = 3.155. p = 0.206
Nhan x e t :
- Ti le lao dpng chin tay va trf 6c tuong duong nhau.
- Khong cd sy khic biet nghe nghifp giiia hai nhdm.
4. Tai diec
Bang 4. Diec tai phai - Diec tai trii va diec ca hai tai Tai diec
Phai T r a Cahai Tong
Thuoc gian m^ch N 65 64 21 150
T y l | % 43.3 42.7 14.0 100.0
Oxy cao a p N 59 46 45 150
Ty le % 39.3 30.7 30.0 100.0
Chung N 124
no
66 300
Tylf % 41.3 36,7 22.0 100.0 X2 = 5.983, p = 0.051
Nhfin x e t : Khdng cd sy khic bift ti If giira diic tai phai vdi diic tai trii.
Bang 5. Phin bd sd tai bi diic d 2 nhdm Tai diec
Nh6ni diec 1 tai / So lai Nh6m diec 2 tai / So tai
T6ng
Thuoc gian mach N 129 42 171
Ty Ie % 75.4 24.6 100.0
Oxy cao ap N 105 90 195
T y l e % 53.8 46.2 100.0
Chung N 234 132 366
Tylf % 63.9 36.1 100,0 X2 = 11.189, p = 0.001
Nhan xet:
- Sd bfnh nhan diic mpt tai nhdm TGM nhilu hon nhdra OXCA cd y nghia thdng kg.
- Sd bfnh nhan dilc hai tai nhdm OXCA nhieu han nhdm TGM cd ^ nghia thdng ke.
T R l f U CHiTNG CO NANG l . U tai
1.1. Trifu cbirng ii tai tnr&c kbi d i l u trj
B a i ^ 6. Trieu chimg ii tai trudc khi dieu tri t l t a l
C6
Thuoc gian mach N 84
T y l | % 56.0
Oxy cao a p N 86
Ty le % 57.3
Chung N 170
Tylf % 56.7
Tdng 150 100.0 150 1000 X2 = 0.054, p = 0.816 Nhan x e t : Ti le c6 trieu chung u tai giira hai nhdm khong cd su khac biet 1.2. Trieu cbung ii tai sau kbi dieu trj
i l l a l Khong thay doi (kem)
Giam (ithS) uk (tfit) Tong
Bang 7. Trieu chiing Thuoc gian mach
N 11 57 16 84
Tylf % 13.1 67.9 19.0 100.0
il tai sau dieu u-|
Oxy cao ap N 6 50 30 86
T y l f % 7.0 58.1 34.9 100.0
''• t
ctew id
N 17 107 46 170
im
62 9 27.1
•lOOJl X2 = 6.167, p = 0.046
Thude gian mach Oxy cao ap Bilu do 1. Trieu chiing ii tai sau dilu trj Nhan x£t:
- Ti le cii thien tdt trieu chiing ii tai nhdm OXCA cao hon nhdm TGM co y nghia thdng kd.
- Tilf u tai khdng Ihay ddi nhdm OXCA thip hon nhdm TGM cd ^ nghia thdng ke.
2. Cbdng m i t
2.1. Trifu chung cbdng n i | t tnrdc kbi dieu tri
g 8. Trieu chiing chdng mit trudc khi dieu tri Ch6ng mat
C6 Khong T6ng
Thuoc gian mach N
34 116 150
Ty If % 22.7 77.3 100.0
Oxy cao iip N 25 125 150
Tylf % 16.7 83.3 100.0
Chung N 59 241 300
Tylf % 19.7 80.3 100.0 X2 = 1.709,p = 0.19I
Nh§n x e t : Ti If cd trifu chiing ehdng mat giOa 2 nhdm nghien ciiu khdng cd sy khic bift Bang 9. Trieu chirng chdng mat sau khi dilu tri
Chong m | t Khong thay doi (k^m)
Giam (khi) H a (tot)
Tong
ThuSc gian mach N 4 21 9 34
Tylf % 11.8 61.8 26.5 100.0
Oxy cao a p N 2 13 10 25
T y l f % 8.0 52.0 40.0 100.0
Chung N 6 34 19 59
T y l f ? 10.2 57,6 32.2 100.0 X2 = 1.258, p = 0.533
- Ti If het hoic cd cii thifn trifu chiing chdng m|t cao d c i hai nhdm.
3. Buon ndn
- Miic dp cai thif n trieu chiing chdng rail giira 2 nhdm khong cd sy khac biet.
Bang 10. Trifu chiing buon non trudc dieu tri Buon ndn
C6 Khong
Tong
Thuoc gian mach N
6 144 150
T y l f % 4.0 96.0 100.0
Oxy cao a p N
3 147 150
T y l e % 2.0 98.0 100.0
Chung N 9 291 300
Ty If % 3.0 97.0 100.0 X 2 = i . 0 3 1 , p = 0.311
Nhan x e t :
- Trifu chiing budn ndn d 2 nhdra chiem ti Ie khdng dang ke - Ti If cd trieu chiing budn ndn giira 2 nhdm khdng cd sy khic biet.
Ca hai nbdm het tri£u chiing buon non sau dieu tri 10 ngiy.
DANH GIA VE THINH LU C
1. Mirc dp cai tblfn TL sau dieu tri giira 2 nbdm OXCA va TGM Bang 11. Miic dp cai thif n thinh lyc sau dieu tri Mirc cai thif n
Kem Kha Tot T6ng
Thuoc gian m^ch N
51 97 23 171
Ty If % 29.8 56.7 13.5 100.0
Oxy cao ap N 35 120 40 195
Ty If % 18.0 61.5 20.5 100.0
Chung N 86 217 63 366
T y l f % 23.5 59.3 17.2 100.0 X2 = 8.468, p = 0.014
Thulc gian mach Oxy cao ap Bilu do 2. Mirc dp cii thifn thinh luc sau dieu tri.
N h | n x e t : Nhdra OXCA cd ti If cii thifn thinh lyc cao hon nhdm TGM cd ^ nghia thdng ke.
2. Mirc dp cai thien TL sau dieu trj tinh theo nbdm dilc 1 tai va nhdm diec 2 tai 2.1 Diec 1 tai
Bang 12. Miic dp cai thifn TL ciia nhdm diec 1 tai sau diSu tri Mih; cai thifn
Kim Khd Tot Tong
Thuoc gian m^ch N
36 79 14 129
T y l f % 27.9 61.2 10.9 100.0
Oxy cao ap N 21 61 23 105
T y l f % 20.0 58 1 21.9 100.0
Chung N 57 140 37 234
Tyle % 24.4 59.8 15.8 100.0
X2 = 6.051, p = 0.048
NhSn x e t : Ti If cai thien thinh lyc tdt nhom OXCA cao han nhdra TGM. ti le cai thifn thinh lyc kem nhdm OXCA thip hon nhdra TGM. sy khic biet nay cd y nghTa thdng ke.
2.2 Dilc 2 tai
Bang 13. Miic cai thien TL cua nhdm diec 2 tai sau dieu tri Mirc cai thifn
Kem Kha T6t Tong
Thuoc gian m^ch N 10 23 9 42
Ty If % 23.8 54.8 21.4 100.0
Oxy cao a p N 12 60 18 90
Ty le % 13.3 66.7 20.0 100.0
Chung N 22 83 27 132
Tylf % 16.7 62.9 20.4 100.0 X2 = 2.563, p = 0.278
Nb^n x e t : Ti If cai thien thi'nh lyc nhom OXCA v i nhdm TGM khac nhau khong cd y nghta thdng ke.
3. Miix dp cii thifn tbinb lux; tinh theo do diec
Bang 14. Die diem thinh Iyc trudc dieu trj xep theo dp diec Df dilc
Nhe Trung binh T.binh n^ng N$ng Sau
Tong
Thuoc gian m^ch N 14 59 45 27 26 171
Ty if % 8.2 34.5 26.3 15.8 15.2 100.0
Oxy cao &p N 37 58 25 62 13 195
Tylf % 19.0 29.7 12.8 31.8 6.7 100.0
Chung N 51 117 70 89 39 366
Tylf % 13.9 32.0 19.1 24.3 10.7 100.0 X2 = 7.054, p = 0 402
N h | n x e t : Die diem thinh lyc trudc dilu tri giiia 2 nhdm khdng cd su khic b Bang 15. Miic dp cai thien thinh luc theo nhdm do diec Df diec
Nhf
Miic cai thien K€m Kha Tot Tong
Thude gian mach N 4 8 2 14
Ty If % 28,6 57,1 14,3 100.0
Oxy cao a p N 7 25 5 37
T y l c % 18.9 67.6 13.5 100.0
Chung N 11 33 7 51
Tylf % 21.6 64.7 13.7 100.0 X2 = 0 615, p = 0.735
Trung binh Kem Khi Tot Tong
13 42 4 59
22.0 71.2 6.8 100.0
9 46 3 58
15.5 79.3 5.2 100.0
22 88 7 117
18.8 75.2 6.0 100.0 X2 = 1.043, p = 0.593
Trung binh nang
K6m Kha Tot Tong
9 25 11 45
20.0 55.6 24.4 100.0
3 19 3 25
12.0 76.0 12.0 100.0
12 44 14 70
17.1 62.9 20.0 100.0 Z2 = 2.918,p = 0,233
NJng Kem 1 8 1 29,6 | 7 | 11,3 | 15 | 16,9
Kha T6t Tong
13 6 27
48.2 22.2 100.0
27 28 62
43.5 45.2 100.0
40 34 89
44.9 38.2 lOO.O _ X2 = 6.433, p = 0.040
Sau
Kem Kha T6t T6ng
17 9 0 26
65.4 34.6 0 100.0
9 3 1 13
69.2 23 1
7.7 100.0
26 12 1 39
66 7 30.8 2.5 100.0 X2 = 2.391, p = 0.302
J ti if cai ihien thinh lyc nhdm OXCA cao han nhdm TGM cd ^ nghia thdng ke (p <
Nhan xfit:
- Nhdm diec n 0.05).
- Nhdm diec siu, miic dp cai thien TL kem d ca 2 nhdra.
5. Mirc dd cai thifn TL theo thoi gian dieu tri sdm hay muon
B a i ^ 16, Phan bo tai diec trudc dieu tri theo thoi gian den kham Ngiiy den kham
< 7 ngay 8 - 1 4 1 5 - 2 1
> 2 1 Tong
Thuoc gian m^ch N
82 65 22 2 171
Tylf % 48 0 38.0 12.9 1.2 100.0
Oxy cao a p N 87 75 30 3 195
T y l e % 44.6 38.5 15.4 1.5 100.0
Chung N 169 140 52 5 366
T y l f % 46.2 38.3 14.2 1.4 100.0 X2 = 0.726. p = 0.867
N h i n x e t :
- Thai gian den kham < 7 ngay va 8 - 1 4 ngay chiem da so.
- Phan bd ti le tai dilc theo ngiy den khim giua hai nhdm khdng cd sir khic biet.
Bang 17. Muc do cai thifn TL theo thdi gian den kham sau dieu tri Ngay den
k h a m
< 7 ngay Mirc cai
thifn Kem KhS T6t Tong
Thuoc gian mach N 24 45 13 82
T y l f % 29 3 54.9 15.8 100.0
Oxy cao dp N 10 57 20 87
Tylf % 11.5 65.5 23.0 100.0
Chung N 34 102 33 169
Tylf % 20.1 60.4 19.5 100.0 X2 = 8 J 2 3 , p = 0.014
8 - 1 4 Kem Kha Tot Tong
15 43 7 65
23.1 66.1 10.8 100.0
16 44 15 75
21.3 58.7 20.0 100.0
31 87 22 140
22.1 62.2 15.7 100.0 Xl - 2.255. p = 0.324
1 5 - 2 1 Kem Kha Tot Tong
11 8 3 22
50.0 36 4 13.6 100.0
7 18 5 30
23.3 60.0 16.7 100.0
18 26 8 52
34.6 50.0 15.4 100.0 X2 = 4.104. p = 0.128
> 2 1 Kem Kha T6t Tong
1 1 0 2
50 0 50 0 0 100.0
2 1 0 3
66.7 33 3 0 100.0
3 2 0 5
60.0 40.0 0 100.0 X2 = 0 142. p = 0.709
Nhan x e l :
- Ti le cai thifn thi'nh lyc nhdra OXCA cao hon nhdm TGM cd y nghia thdng ke ddi vdi nhdm din kham < 7 ngiy (p < 0.05)
- Nhdm din khim sau 21 ngiy ti le cai thifn kem d ca 2 nhdm nghidn ciiu.
BAN L U ^ N
Trong 300 trudng hop DDN duoc nghien ciiu, chiing tdi thay cd nhung die diem sau:
1. Tuoi:
2. Tudi trung binh cho ca 2 nhdm la 40 63± 12.39, trong dd nhdm TGM l i 39.54 ± 12 74, nhdm OXCA la 41.72 ± 11.97. Phan bd ti le giira cac nhdm luoi cting nhu tudi trung binh 2 nhdra TGM va OXCA khdng cd su khic bift (p > 0.05)
3. Gidi tinh:
4. Ti le nara nii tuong duang nhau, nam cd 156 benh nhan {chiem 52%), nir c6 144 bfnh nhan {chiem 48%). Sy phin bd ti le nara, nii giira hai nhdm TGM v i OXCA khdng cd sy khac bift (p > 0.05) 3. Ngbe nghifp:
Cin bp cdng nhan vien (CBCNV) chilm 141 ngudi (ti le 47%), cdng nhan 137 ngudi (ti If 45.7%). Cac thanh phin khdc chii yeu la hpc sinh, sinh vien, nhdm nay cd 22 ngudi (ti ie 7.3%), Sy phan bd ti If nghe nghifp giila hai nhdm TGM vi OXCA khdng cd su khac biet (p > 0.05).
Nhu v|y, DDN khdng lien quan den nghl nghiep (lao dpng chin tay hay tri dc), ngoai trit cic nghl nghifp d^c thii nhu ngudi ihudng xuydn tiep xdc vdi tiing on Idn v i cuong dp lao dpng cao, ngudi lim viec d moi trudng i p suit tay ddi mi chiing tdi khdng gap d nghidn ciiu niy.
5. Tai dilc:
6. So bfnh nhin dilc mdt tai Ii 234 (ti If 78,0%), irong nhdm dilc mpt tai thi dilc tai phai la 124 bfnh nhan{tilf 41.5%), dilc tai trii 110 bfnh nhin (ti If 36.7%). Ti If giiia dilc tai phai va dilc tai trai tuong duong nhau. Sd benh nhan dilc hai tai Ii 66 ngudi (vdi 132 tai) (ti If 22.0%), trong dd nhdm TGM cd 21 bfnh nhan (ti If 14,0%), nhdm OXCA c6 45 bfnh nhan (ti If 30.0%).
Nhu vgy, ti If diec mdt tai chilm da s6, dilc tai phai va dilc tai trii khdng cd su khic bift, nhdm OXCA diec hai tai nhieu hon nhdm TGM.
TRI$U C H C > 4 G CO NANG 1. tl tai:
2. Bfnh nhan cd trifu chiing ii tai ca hai nhdm l i 170 ngudi (ti If 56.7%), trong dd nhdm TGM cd 84 benh nhan (ti If 56.0%), nhdm OXCA 86 benh nhan {ti If 57.3%). Ti le bfnh nhin cd ii tai giOa 2 nhdm khdng cd su khic bift (p > 0.05). Sau dieu tri nhdm OXCA cd ti If hit ii cao hon nhdm TGM, sy khac bift niy cd ^ nghTa thdng ke {p < 0.05).
3. Cbdng m i t :
4. Trifu chiing chdng mat d ci hai nhdm ed 59 bfnh nhan (ti If 19.7%), trong dd nhdm TGM 34 bfnh nhan (ti le 22.7%), nhdm OXCA 25 benh nhan (ti If 16.7%). Sau dilu tri ti If cd cii thifn va hit chdng mit ci hai nhdm l i 89.8%, nhdm TGM la 88.2%, nhdm OXCA l i 92.0%. Ti le cd cai thien trifu chiing chdng mit d 2 nhdm OXCA va TGM khic nhau khong cd •$ nghia thong kg (p > 0.05).
3. Trieu chuTig buon non:
Tnfu chdrng budn ndn chung tdi gap 9 bfnh nhan (ti If 3.0%), trong dd nhdm TGM cd 6 bfnh nhan (ti le 4.0%), nhdm OXCA 3 bfnh nhan {U If 2.0%). Sau dilu tri hai nhdm diu het tneu chiing budn ndn.
DAC DIEM VE T H I N H L y C
1. Mirc dp cai thifn TL sau dieu tri giira 2 nbdm TGM va OXCA
+ Nhdm TGM: Ti If cd cai thien thinh Iye l i 70.2%, trong dd cai thien tdt l i 13.5%, cai thien kha 56.7%, cai thifn kdm 29.8%.
+ Nhdm OXCA. Ti le cd cai thifn thinh lyc la 82 0%, trong dd cai thifn tdt chilm 20.5%, cai thifn khi 61.5%, cai thifn kdm 18.0%. Nhdm OXCA ti If cai thien cao hon TGM cd ^ ngWa thdng ke (p < 0.05).
Chung ldi cho iing cd the trong diec dpt ngpt PO2 giim ding ke trong cic khoang djch tai trong dan din rdi loan sit npi - ngoai bao, OXCA da lam tang PO2 din din kha ning cai thifn thinh luc cao han.
2. Mot; do cai thien TL tbeo nbdm dilc I tai va diec 2 tai 2.1. Nbdm diec 1 tai:
Ti If cd cii thien thinh tyc sau dilu tri c i 2 nhdm la 75.6%. Ti Ie cd cai thien nhdm TGM la 72 17f;
nhdm OXCA l i 80.0%, cao hon TGM cd f nghia ihdng ke (p < 0.05).
2.2. Nhom dilc 2 t a i :
Ti If cd cii thien thi'nh lyc ca 2 nhdm l i 83.3%. Ti If cd cai thifn thi'nh luc nhdm TGM Ii 76.2% nhdm OXCA la 86.7%, c6 xu hudng cao han nhdm TGM, tuy nhien su khac biel nay chua cd y nghia thdng ke (p >
0.05).
3. MlTC cai thien tbinh lyre ti'nh theo dp diec
Trudc dilu tri nhdm dilc nhe cd 51 trudng hpT) (ti If 13.9%), dilc trung binh 117 trucmg hop (ti le 32.0%), dilc trung binh nang 70 trudng hgp (ti If 19.1%), diec ning 89 trudng hop (ti If 24.3%), dilc sau 39 tnrdng hop (ti If 10,7%). Sir phan bd dp dilc giua hai nhdm TGM va OXCA khic nhau khdng cd S nghTa thdng kg (p > 0,05). Sau dieu tri chdng tdi thiy:
+ Ti If cii thien thinh lyc khdng tuong quan vdi miic dp diec (ngoai tru nhdm diec sau).
+ Ti If cii thien thi'nh lyc nhdm OXCA cao ban TGM. sy khac biet cd J nghia thdng ke (p < 0.05) doi vdi nhdra diSc nang.
-I- Diec siu ti If cai thien thinh lyc kem d ca 2 nhdm OXCA va TGM.
4. Miix do cai thifn tbinh lire tbeo thfri gian den dieu tri
Nhdm,OXCA cd ti If cii thifn thinh luc cao han nhdm TGM, su khac bift cd y nghTa thdng ke (p < 0.05) ddi vdi nhdm benh nhin din kham trong tuin diu (< 7 ngiy).
Ti If cii thifn thinh luc giara din theo thdi gian din khim ddi vdi ca hai nhdm.
Ti le cai thien kem 6 ca hai nhdm nlu thdi gian din khim v i dilu m sau 3 tuin {> 21 ngiy).
KETLUi^N
1. H II cai thifn DON do dieu tri b i n g TGM nbir sau :
- Ti ie cd cai thifn trieu chiing ii tai la 86,9%, ed cai thien trieu ehiing chdng mat 88.2%. cd cai thien trieu chiing budn ndn 100%.
- Ti le c6 cai thien thinh lyc chung Ii 70.2%, cd cai thien thinh Iye nhdm diec rapt tai 72.1%, cd cai thifn thi'nh lyc ddi vdi nhdm dilc ning 70.4%.
- Ti If cd cai thifn thinh lyc doi vdi nhdm den khim trong tuin dau (< 7 ngay) la 70.7%.
2. Ti If cai thifn DDN do dilu tri b^ng OXCA nhir sau :
- Ti le cd cii thien trifu chimg ii tai l i 93.0%, cao hon nhdra TGM cd y nghia thdng ke.
- Ti If cd cai thien trieu chiing chdng miit la 92.0%, cd xu hudng cao hon nhdm TGM. Tuy nhien, sy khic biet niy khong cd y nghia thdng ke (p > 0.05).
- Ti If cd cai thifn trifu chiing budn ndn li 100%, tuong duang nhdm TGM.
- Ti If c6 cai thifn thinh lyc chung la 82.0%, cd cii thifn thinh lyc nhdm diec mdt tai la 80.0%, cd cai thifn thinh Iyc nhdm diec nang la 88.7%, cao hem nhdm TGM cd y nghTa thdng kd.
3. Ti If cd cii thifn thinh lue ddi vdi nhdm bfnh nhan den kham trong tuin diu (< 7 ngiy) la 88.5%, cao han nhdra TGM cd y nghTa thdng ke.
4. Nhiing yeu td tien lugng phye hdi kem cho ca 2 nhdm la: Tuoi > 50, diec 2 tai, thdi gian den dieu in mudn (sau 3 tuan).
DE N G H !
1. DDN dugc dieu tri theo phic do quy udc, nlu sau 5 ngiy thinh lyc khong cai thien, hoac cai thifn < 10 dB nen dugc dieu tri OXCA ket hgp.
2. Thdi gian dieu tri OXCA nfin thyc hifn trudc 2 tuan, vdi ap suit dieu tri la 2.5 atra x 60 phdt x 10 ngiy.
TAI L i f u THAM KHAO
I. Auhor Affiliation, 'Treatment of Sudden Sensorineural Hearing Loss", Departments Otolaryngolory university of Ottawa, Ottawa, Ontario (Dr Colin), and university of Western Ontario, London (Dr Fames).
Downloaded from www.archoto.com on March 23, 2009.
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