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体外循环手术对听觉功能的影响:一项初步研究。

Effects of cardiopulmonary bypass surgery on auditory function: a preliminary study.

作者信息

Munjal Sanjay Kumar, Malik Parul, Sharma Anuradha, Panda Naresh Kumar, Thingnum Shyam K Singh

机构信息

Speech and Hearing Unit, ENT Department, New OPD, Postgraduate Institute of Medical Education & Research, 4th floor, Chandigarh 160012, India.

出版信息

ISRN Otolaryngol. 2013 Aug 29;2013:453920. doi: 10.1155/2013/453920. eCollection 2013.

Abstract

Hearing loss has been reported as a complication following cardiac surgery with extracorporeal circulation. Preoperative hearing testing is not commonly done in these procedures, so preoperative and postoperative hearing loss, if any, may occur unnoticed. 30 subjects in the age range of 50-70 with a mean age of 60.16 years with myocardial infarction and scheduled to undergo cardiopulmonary bypass surgery underwent detailed audiological assessment comprising of pure tone audiometry with extended high frequency audiometry, speech audiometry and otoacoustic emissions (OAE) testing. The audiological testing was done preoperatively and at 2 weeks after the surgery. On pure tone audiometry, the difference between pre- and postsurgery mean values for both ears at 10, 12, and 16 KHz showed highly significant differences (P < 0.0001). On OAE testing, a significant difference (P < 0.05) between pre- and postvalues of signal to noise ratio (SNR) was found. It is hypothesised that CPB surgery makes blood redistribution to other organs easy, deviating from internal ear, which is highly susceptible as it lacks collateral circulation and its cells have high energy metabolism. Epithelial damage on internal ear microcirculation causes reduction of the cochlear potentials and hence hearing loss.

摘要

据报道,体外循环心脏手术后会出现听力损失这一并发症。在这些手术中,术前听力测试并不常见,因此术前和术后的听力损失(如果有的话)可能未被注意到。30名年龄在50 - 70岁之间、平均年龄为60.16岁的心肌梗死患者计划接受体外循环手术,他们接受了详细的听力学评估,包括纯音听力测试(扩展高频听力测试)、言语听力测试和耳声发射(OAE)测试。听力学测试在术前和术后2周进行。在纯音听力测试中,双耳在10、12和16千赫兹处术前和术后平均值的差异显示出高度显著差异(P < 0.0001)。在耳声发射测试中,发现信噪比(SNR)术前和术后值之间存在显著差异(P < 0.05)。据推测,体外循环手术使血液易于重新分配到其他器官,偏离了内耳,内耳因缺乏侧支循环且细胞具有高能量代谢而极易受到影响。内耳微循环的上皮损伤导致耳蜗电位降低,进而导致听力损失。

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本文引用的文献

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Hearing loss after cardiopulmonary bypass surgery.体外循环心脏手术后的听力损失
Eur Arch Otorhinolaryngol. 2000;257(3):124-7. doi: 10.1007/s004050050207.
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Hearing loss in critical care: an unappreciated phenomenon.
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