Wilhelm H J, Jung F, Kiesewetter H, Recktenwald C
Klin Wochenschr. 1986 Oct 15;64(20):1058-61.
In cases of sudden loss of hearing, it must be assumed that a microcirculatory disturbance is involved, on the basis of a vasospasm of the afferent blood vessels and a "sludging phenomenon" in the region of the distal end-arteries of the cochlea. The microcirculatory disturbance results in an impairment of the O2 concentration in the perilymph, which can bring about disturbances, which are usually of short duration, and reversible changes in metabolism and structure of the hair cells. For this reason the therapeutic objective should be a reduction in the blood viscosity and flow resistance, plus a reduction in surface tension and an influence on the glycogenolytic metabolism of the erythrocytes. The therapeutic concept here is to be sought in a hypervolaemic haemodilution therapy with plasma substitutes. Care should be taken in the selection of the plasma substitute that not only parameters crucial to the macrocirculation are influenced, such as PCV and whole blood viscosity, but also those significant for the microcirculation, such as plasma viscosity and erythrocyte aggregation. A rheologically effective plasma expander would appear to have been found in the 10% hydroxyethyl starch 200/0.5, which together with naftidrofuryl would appear to be a proven agent in the combination therapy for sudden loss of hearing, due to its positive effect on plasma viscosity and erythrocyte aggregation, as shown by the significantly better mean increase in hearing on completion of therapy.
在突发性听力丧失的病例中，基于传入血管的血管痉挛以及耳蜗远端终末动脉区域的“血液淤滞现象”，必须假定存在微循环障碍。这种微循环障碍会导致外淋巴中氧浓度降低，进而引发通常为短暂性的功能障碍，以及毛细胞代谢和结构的可逆性变化。因此，治疗目标应是降低血液粘度和血流阻力，同时降低表面张力并影响红细胞的糖原分解代谢。此处的治疗理念在于采用血浆代用品进行高血容量血液稀释疗法。在选择血浆代用品时应谨慎，不仅要考虑对大循环至关重要的参数，如红细胞压积和全血粘度，还要考虑对微循环有重要意义的参数，如血浆粘度和红细胞聚集。10%羟乙基淀粉200/0.5似乎是一种具有流变学效应的血浆扩容剂，由于其对血浆粘度和红细胞聚集有积极作用，治疗结束时听力平均改善明显，因此它与萘呋胺酯联合使用似乎是治疗突发性听力丧失联合疗法中已得到验证的药物。
