NEJM:前庭假体植入后患者的姿势,步态,生活质量及听力改变

2021-02-11 MedSci原创 MedSci原创

全世界约有180万成年人患有严重的双侧前庭功能低下,由于前庭反射无法稳定眼睛,头部和身体,导致不平衡,振荡,姿势不稳和步态不稳。 由于受影响的人必须专心致志地步行而不摔倒,因此他们注意力分散,摔倒的风

导语:人工耳蜗的作用

 

全世界约有180万成年人患有严重的双侧前庭功能低下,由于前庭反射无法稳定眼睛,头部和身体,导致不平衡,振荡,姿势不稳和步态不稳。 由于受影响的人必须专心致志地步行而不摔倒,因此他们注意力分散,摔倒的风险是未受影响的人的31倍,还有“像醉汉一样走路”的社会烙印。 不仅如此,他们还负担着与疾病相关的经济压力,生活质量严重下降,与成人发作的严重双侧听力减退或肾功能不全引起的疾病相似。


当前的实践练习包括指导这些患者进行前庭康复锻炼,避免使用耳毒性药物(例如氨基糖苷类)和镇静药物(例如美氯嗪和苯并二氮杂类),并避免参加伤害风险较高的活动(例如,游泳,在光线不足的地方行走或驾驶)。使用声音,皮肤振动或电流刺激的非侵入性设备可以传达有关身体运动和方向的足够信息,以减少姿势不稳。 但是,这些帮助对于步态的改变并没有什么有效的作用。


在三个中心,22名患者接受了改良的人工耳蜗植入,该人工耳蜗使用电极电刺激前庭神经分支。 此类设备仅在实验室环境中进行过测试。 研究人员据此进行了一项研究,以测量单侧前庭植入物的临床效果,该植入物通过电刺激支配半规管的前庭神经分支来提供每天长达24小时的头部运动的感觉。


由于耳毒性(7名参与者)或特发性(1名参与者)导致双侧前庭功能减退2至23年的人,接受了单侧植入,以电刺激前庭神经的三个半规管分支的假体。 临床结果包括Bruininks-Oseretsky运动能力测验平衡子测验的分数(范围为0到36,得分越高表示平衡性越好),改进的Romberg测验的失败时间(范围为0到30秒), 动态步态指数(范围为0到24,得分越高表示步态性能越好),完成“定时走”测试所需的时间,步态速度,纯音听觉检测阈值,语音辨别力得分和生活质量。 我们将参与者在基线(植入前)的结果与6个月(8位参与者)和1年(6位参与者)的结果进行了比较,并将该设备设置为其常规治疗模式(不同的刺激脉冲率和幅度代表旋转头运动) 及安慰剂模式(保持脉冲频率和幅度恒定)。


Bruininks–Oseretsky检验在基线和6个月时的中位数分别为17.5和21.0(参与者内部差异中位数为5.5分; 95%置信区间[CI]为0至10.0); 修改后的Romberg测试的中位数时间分别为3.6秒和8.3秒(差异为5.1; 95%[CI]为1.5至27.6); 动态步态指数的中位数分别为12.5和22.5(差异为10.5分; 95%[CI]为1.5至12.0); “定时走”测试的中位时间分别为11.0秒和8.7秒(差异为2.3; 95%[CI]为-1.7至5.0); 步态速度测试的中值速度为每秒1.03 m和每秒1.10 m(差异为0.13; 95%[Cl]为-0.25至0.30)。 安慰剂模式测试证实,改善是由于治疗模式刺激所致。 在进行了1年评估的6名参与者中,参与者从基线到1年的中位变化通常与6个月的结果一致。 在6个月时,植入引起同侧听力损失,空气传导纯音平均检测阈值5位参与者增加了3至16 dB,3位参与者增加了74至104 dB。 参与者报告的残疾和生活质量的变化与姿势和步态的变化平行。

实验结果表明,在六个月或一年时,单侧植入前庭假体的患者姿势,步态和生活质量的测量均有所改善,但除了一名参与者,植入物在所有情况下均降低了耳朵的听力。

原文链接:https://www.nejm.org/doi/full/10.1056/NEJMoa2020457?query=featured_home

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    2021-07-09 xxxx1061
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    2021-02-13 carrotlyl

    好文

    0

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    2021-02-13 ysjykql
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  5. [GetPortalCommentsPageByObjectIdResponse(id=1741974, encodeId=5d581e419746b, content=<a href='/topic/show?id=5681632e84e' target=_blank style='color:#2F92EE;'>#步态#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=63278, encryptionId=5681632e84e, topicName=步态)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=76f034999566, createdName=xxxx1061, createdTime=Fri Jul 09 00:29:40 CST 2021, time=2021-07-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=924386, encodeId=4f49924386e8, content=好文, beContent=null, objectType=article, channel=null, level=null, likeNumber=72, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210127/50a003c4097845e182c08afd64d8a509/bd766dfebe9c40e0bca2dae964601bdc.jpg, createdBy=22de5454917, createdName=carrotlyl, createdTime=Sat Feb 13 08:14:15 CST 2021, time=2021-02-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1306621, encodeId=60841306621ab, content=<a href='/topic/show?id=aeb639230b7' target=_blank style='color:#2F92EE;'>#听力#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=39230, encryptionId=aeb639230b7, topicName=听力)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=96d4340, createdName=ysjykql, createdTime=Sat Feb 13 01:29:40 CST 2021, time=2021-02-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1468361, encodeId=8c8b14683615c, content=<a href='/topic/show?id=2d3d2e5176a' target=_blank style='color:#2F92EE;'>#假体#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=27517, encryptionId=2d3d2e5176a, topicName=假体)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=2b576903125, createdName=lanyan20020088, createdTime=Sat Feb 13 01:29:40 CST 2021, time=2021-02-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1520728, encodeId=1b9c1520e286e, content=<a href='/topic/show?id=7a736264553' target=_blank style='color:#2F92EE;'>#植入#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=62645, encryptionId=7a736264553, topicName=植入)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=832411313664, createdName=jiyangfei, createdTime=Sat Feb 13 01:29:40 CST 2021, time=2021-02-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1035571, encodeId=06b310355e165, content=顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Thu Feb 11 13:29:40 CST 2021, time=2021-02-11, status=1, ipAttribution=)]
    2021-02-13 jiyangfei
  6. [GetPortalCommentsPageByObjectIdResponse(id=1741974, encodeId=5d581e419746b, content=<a href='/topic/show?id=5681632e84e' target=_blank style='color:#2F92EE;'>#步态#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=63278, encryptionId=5681632e84e, topicName=步态)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=76f034999566, createdName=xxxx1061, createdTime=Fri Jul 09 00:29:40 CST 2021, time=2021-07-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=924386, encodeId=4f49924386e8, content=好文, beContent=null, objectType=article, channel=null, level=null, likeNumber=72, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210127/50a003c4097845e182c08afd64d8a509/bd766dfebe9c40e0bca2dae964601bdc.jpg, createdBy=22de5454917, createdName=carrotlyl, createdTime=Sat Feb 13 08:14:15 CST 2021, time=2021-02-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1306621, encodeId=60841306621ab, content=<a href='/topic/show?id=aeb639230b7' target=_blank style='color:#2F92EE;'>#听力#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=39230, encryptionId=aeb639230b7, topicName=听力)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=96d4340, createdName=ysjykql, createdTime=Sat Feb 13 01:29:40 CST 2021, time=2021-02-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1468361, encodeId=8c8b14683615c, content=<a href='/topic/show?id=2d3d2e5176a' target=_blank style='color:#2F92EE;'>#假体#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=27517, encryptionId=2d3d2e5176a, topicName=假体)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=2b576903125, createdName=lanyan20020088, createdTime=Sat Feb 13 01:29:40 CST 2021, time=2021-02-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1520728, encodeId=1b9c1520e286e, content=<a href='/topic/show?id=7a736264553' target=_blank style='color:#2F92EE;'>#植入#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=62645, encryptionId=7a736264553, topicName=植入)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=832411313664, createdName=jiyangfei, createdTime=Sat Feb 13 01:29:40 CST 2021, time=2021-02-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1035571, encodeId=06b310355e165, content=顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Thu Feb 11 13:29:40 CST 2021, time=2021-02-11, status=1, ipAttribution=)]
    2021-02-11 旺医

    顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息

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