中国高压氧治疗噪声性聋临床疗效的Meta分析

Effects of hyperbaric oxygenations in treatment of noise induced hearing loss in China: A meta-analysis

  • 摘要:
      背景  噪声性聋(noise induced hearing loss,NIHL)指由于听觉长期遭受噪声影响而发生缓慢的进行性感音性耳聋,随着病程的进展还可引起头痛、头昏、失眠、高血压等,因无较好的治疗方法,治疗效果较差,严重影响飞行安全。
      目的  系统评价高压氧(hyperbaric oxygenations,HBO)治疗NIHL的临床效果,以期更有效地指导临床治疗。
      方法  检索中国知网、万方数据库、维普数据库及PubMed等数据库,纳入HBO治疗NIHL的随机对照试验(观察组干预措施为使用HBO,对照组不使用HBO,两组患者可同时使用药物或其他治疗),不设置检索时间,最后检索时间为2020年1月。按照Jadad质量计分法对纳入的临床随机对照试验进行方法学质量评估,采用RevMan 5.3.0进行Meta分析。
      结果  共纳入符合分析要求的4篇临床随机对照试验,涉及284例患者,其中观察组142例,对照组142例。Meta分析结果显示,经HBO治疗后NIHL患者纯音测听0.5 kHzMD=-5.95,95% CI:-7.14~-4.74,P<0.01、1 kHzMD=-4.45,95% CI:-5.34~-3.56,P<0.01、2 kHzMD=-4.58,95% CI:-5.69~-3.47,P<0.01、4 kHz MD=-11.75,95% CI:-13.73~-9.77,P<0.01听阈改善程度高于对照组,无不良反应报道。
      结论  HBO治疗可降低NIHL患者纯音测听0.5 kHz、1 kHz、2 kHz、4 kHz频率的听阈,无明显不良反应,但阈值降低程度有限,需高质量的临床研究加以验证。

     

    Abstract:
      Background  Noise induced hearing loss (NIHL) is a slow progressive sensorineural deafness which can cause headache, dizziness, insomnia, hypertension, etc by the development of disease. Due to no effective treatment, it will seriously affect flight safety.
      Objective  To evaluate the effects of hyperbaric oxygenations (HBO) in treating NIHL, and provide more effective guidance for clinical treatment.
      Methods  Randomized controlled trials of HBO-treated NIHL (the experimental group was given HBO for intervention while the control group was not, both groups could be treated with other drugs or intervention) were retrieved from databases of CKNI, Wanfang, VIP and PubMed. The methodological quality assessment on included literature was processed by Jadad quality scoring method, and RevMan 5.3.0 was adopted to conduct Meta-analysis.
      Results  A total of 4 clinical randomized controlled trials met the inclusion criteria, including 284 patients (142 cases in experimental group and 142 cases in control group). Results of meta-analysis indicated that after HBO treatment, there was a statistically significant improvement of NIHL patients’ pure ton auditory threshold 0.5 kHz MD=-5.95, 95%CI(-7.14 - -4.74), P<0.01, 1 kHz MD=-4.45, 95% CI (-5.34 - -3.56), P<0.01, 2 kHz MD=-4.58, 95% CI (-5.69 - -3.47), P<0.01, 4 kHz MD=-11.75, 95% CI (-13.73 - -9.77). No adverse reaction was reported.
      Conclusion  HBO treatment in NIHL patients can reduce the PTA threshold at 0.5 k, 1 k, 2 k, 4kHz without side effects. However, the PTA threshold reduction is need to be verified by high-quality clinical studies.

     

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