【作者】 袁媛；

【导师】 靳瑞；

【作者基本信息】 广州中医药大学 ， 针灸学， 2000， 博士

【摘要】 针刺治疗儿童神经性耳聋的临床及实验研究 博士生 袁 媛 导 师 靳 瑞 教授 协助导师 赖新生 教授 明顺培 教授 摘 要 儿童神经性耳聋是指由于儿童期螺旋器毛细胞、听神经、听传导径路或各级神经元受损害，所导致的神经冲动传递障碍。儿童神经性耳聋主要表现为听力下降甚或听力完全丧失，临床包括药物中毒性耳聋，感染性耳聋，外伤性神经性耳聋等。本病的病因主要有遗传因素，如遗传性内耳发育不全，家族感觉性聋等，孕妇妊娠期患风疹或其他病毒感染，毒血症，肾炎等，或妊娠期使用链霉素等耳毒性药物；围产期因素主要有产伤、核黄疸、产后窒息等；婴幼儿期使用链霉素等氨基糖甙类抗生素；感染性疾病以及外伤、噪声等因素。由于耳蜗毛细胞、听神经纤维末梢和螺旋神经节紧密相联，病变往往同时波及这几个部位，甚至累及听神经或听中枢。中医对本病的论述分散在“耳聋”、“耳鸣”、“失聪”、“耳无所闻”等病种中。对其症状，病机及治疗均有详细记载。一、临床研究（一）针刺治疗54例儿童神经性耳聋疗效观察 本组病例针刺组54例（96耳），总有效率87．5％；药物对照组32例（53耳），总有效率65．1％。差异有显著性（P＜O．05）。针刺组疗效与耳聋程度及致病因素相关，轻、中度耳聋疗效较重度耳聋显著；药毒性耳聋及感染性耳聋疗效较先天性耳聋为好，先天性聋疗效最差。“靳三针疗法”是一组特定取穴的针灸疗法，是靳瑞教授多年临床实践的总结。此法尤重视头针的应用，以取头部及耳部穴位为主，以调节诸经经气，疏通局部气血。（二）针刺治疗对儿童神经性耳聋脑干听觉诱发电位的影响 通过对针刺组35例（59耳），药物对照组20例（34耳）ABR阈值、ABR潜伏期及波间期的影响的观察，针刺组患儿ABR听阈下降明显，提示针刺对听觉系统的治疗作用明显优于药物组；针刺组＊皿J波潜伏期同药物对照组比较＊皿＊波潜伏期有显酣缩短O＜o．05人各波间期＊一皿、卜V间期）无显著性差异O＞0．05L而皿一二V波间期与药物组比较有显著性缩短帜＜O．05人说明针刺在一定程度上可以改善听觉系统的功能，尤其是改善耳蜗的功能。二、动物实验研究（一）针刺对豚鼠庆大霉素中毒性耳聋听觉脑干诱发电位的影响 通过36只模型组豚鼠与正常组豚鼠ABR阈值比较有非常显著性差异，经庆大霉素造模后豚鼠的ABR阈值显著升高，提示庆大霉素对豚鼠的听觉系统有明显损害，造模成功。造模组各波潜伏期均较正常组明显延长，说明庆大霉素不仅损害耳蜗，同时也损害听觉中枢，但仍以耳蜗为主。 36只模型动物随机分为针刺组、药物组、模型组各12只，各组豚鼠治疗后ABR阈值组间比较具有显著性差异，证明针刺雌型动物的听觉损害具有较好的改善，动物的听力明显提高，针刺对豚鼠的听力改善明显优于常规药物治疗。针刺组各波潜伏期均比模型组与药物组缩短，其中以互波、皿波潜伏期缩短明显①＜0．01L提示针刺可以改善庆大霉素的耳毒性对听觉的损害，尤以对耳蜗的保护作用明显。（二＊针刺对豚鼠庆大霉素中毒性耳聋的耳蜗组织学观察 耳蜗基底渊片正常组耳蜗螺旋器三排外毛细胞轮廓清楚，排列整齐，“V”形听毛染色清晰，各回毛细胞无缺失；模型组耳蜗损伤较重，底回及第 皿二回有大量的外毛细胞坏死且累及邻近的柱细胞和内毛细胞。药物组外毛细胞呈节段性缺失，常波及二、三排，基本病理形态改变与模型组相似，无明显差异。针刺组耳聋豚鼠耳蜗各回损伤程度均低于模型组，毛细胞的缺失相对较少，局限于底回及第一排，细胞肿胀、渗出等较轻。更多还原

【Abstract】 Children’s nerve deafness, including drug poisoning deafness, infectious deafness and in juring nerve deafness, is one transmission obstruct of nerve impulse because of the in juring of hair cells, auditory pathway or kinds neuron during child. Its main feature is the decent of hearing or lull loss of hearing. There are fine factors to lead to this disorder. Heredity is the first factor, for example, patient’s internal ear is not developed well because of heredity and feeling deafness because of family dependents. Secondly, pregnant is suffered from urbella or other virus such as toxemia and nephritis, or uses some ototox- tcity medicines such as streptoimycin. Thirdly, infant is wounded when he was born, and suffered from nuclear jaundice or postpartum choke. Fourthly, infant was treated by antibiotic medicines such as streptomycin. Fifthly, patient is suffered from infectious disease, injuring, noise and so on. Patient?s cochlea hair cells, auditory nerve fiber ending, spiral ganglion and even hearing nerve and hearing center are always affected simultaneously by this disease because they are related closely. This syndrome is described as deafness, linnitus, in- Sensitive to ear and unhearing etc. The symptoms and pathogenesis as well as treatment have been recorded. Clinical study (--) Efficacy of acupuncture therapy in treatment of 54 cases of children nerve deafness Total effective rate of 54 cases (96 ears) treated by acupuncture (87. 5% is remarkably higher than that of 32 cases (53 ears) treated by drugs (65. 1%) (p ~O. 05) . The efficacy of acupuncture therapy is related with the degree of deafness and the factors causing this disorder. The efficacy of light and middle degree patients is significantly higher than that of heavy degree patients. The efficacy of patients caused by drugs and infection is higher than that of con- genital patients. un Three needle regimen is a special therapy by selecting a group of special points which summarized many year experiments of Prof. Jin Rui. Application of scalp therapy is especially emphasized in this regimen which main points distribute on scalp and ear. This therapy mainly regulates the Qi of many channels and promotes some Qi points. (二) Influence on the nerve hearing evoked potential of brain trunk in children? s nerve deafness with acupuncture therapy There exist remarkably differences among ABR hearing threshold, ABR incubation period and wave period through comparing 35 cases (59 ears) treated by acupuncture therapy and 20 cases (34 ears) treated by drugs. The patient’s ABR threshold with acupuncture therapy is obviously decreased. This effect indicates that the efficacy with acupuncture therapy on hearing system is sig- nificantly superior to that with drugs, that incubation period of 1, III and V waves with acupuncture therapy is remarkably shorter than that with drugs (p < 0. 05). In addition, author also found that there are no obviously differences in I ?III arl(l 1 ?V wave spans between the treatments by acupuncture therapy and by drugs (p > 0. 05), but the wave span of III ?V treated by acupuncture therapy is clearly shorter than that by drugs (p <0. 05). All above, to a certain extent, show that acupuncture therapy can improve the function of hearing sys- tem, especially improve the function of cochlea. Experiment in animals Influence (in the hearing evoked potential of brain trunk in gentamicin cavy with ac poisoning deafness更多还原