老年突发性耳聋患者住院期间身心状态对治疗效果的影响

Influence of mental and physical state on therapeutic effect of elderly patients with sudden deafness during hospitalization

【摘要】目的 调查老年突发性耳聋(SD)患者住院期间身心状态,并分析其对治疗效果的影响。方法 选择首都医科大学附属北京友谊医院2021年6月至2023年6月收治的150例老年SD患者为研究对象(SD组),同期于医院行健康体检的同龄无听力障碍者作为对照组(n=50)。采用简明健康状况量表(SF-36)调查被研究者生活质量。以SF-36量表平均总得分为依据,将SD组SF-36总得分≥平均分者纳为高生活质量组(n=66),SF-36总得分＜平均分者作为低生活质量组(n=84),治疗1~3个疗程后评估患者的治疗效果。采用SPSS 22.0统计软件进行数据分析。根据数据类型,分别采用t检验或χ²检验进行组间比较。采用多因素logistic回归模型分析患者生活质量的影响因素。采用Spearman相关性分析评估老年SD患者生活质量与治疗效果的相关性。结果 治疗前,SD组患者SF-36量表中生理功能(PF)、躯体疼痛(BP)、社会功能(SF)、精神健康(MH)维度及量表总得分均低于对照组,差异有统计学意义(P<0.05)。治疗后,SD组总有效率为48.67%(73/150),其中高生活质量组患者治疗总有效率为59.09%(39/66),高于低生活质量组的40.48%(34/84),差异有统计学意义(P<0.05)。Spearman相关性分析提示,SD组患者SF-36总得分与其治疗效果呈正相关(r=0.211；P=0.023)。多因素logistic回归分析提示,发病至就诊时间＞7d(OR=3.084,95%CI 1.529~9.463)、眩晕(OR=2.125,95%CI 1.245~3.629)、睡眠障碍(OR=4.768,95%CI 2.122~10.713)、焦虑(OR=1.923,95%CI 1.330~2.780)、A型人格特征(OR=5.714,95%CI 1.481~22.053)及急性应激障碍(ASD)(OR=4.191,95%CI 1.518~11.568)是影响老年SD患者生活质量的危险因素；而积极应对方式(OR=0.389,95%CI 0.200~0.760)是其保护因素。结论 老年SD患者生活质量较同龄人明显下降,其生活质量与治疗效果存在相关性,除必要的治疗干预外,建议临床增强对患者生活质量的关注,并从改善睡眠、情绪梳理、应对方式调节等方面出发,改善患者住院期间生活质量。

基金项目:北京市医院管理中心“登峰”计划专项经费(DFL20220102)

【Abstract】Objective To investigate the mental and physical state of elderly patients with sudden deafness during hospitalization (SD), and to analyze its influence on therapeutic effect. Methods A total of 150 elderly SD patients admitted to our hospital from June 2021 to June 2023 were recruited and served as SD group, and another 50 age-matched individuals who took physical examination during the same period and had no hearing impairment were enrolled and subjected as control group. The short-form-36 health survey (SF-36) was used to investigate the quality of life (QOL) of SD group, and based on the average SF-36 total score, the elderly SD patients with the total score≥ the average score were assigned into a high QOL group (n=66), and those with the total score < average score into a low QOL group (n=84). The efficacy of their treatment was evaluated in 1-3 courses of treatment. SPSS 22.0 was used for data analysis. Depending on data type, student′s t test or Chi-square test was performed for intergroup comparison. Multivariate logistic regression model was employed to determine the related factors affecting the QOL of the patients. Spearman correlation analysis was utilized to evaluate the correlation between QOL and therapeutic efficacy in the elderly SD patients. Results Before treatment, the scores of dimensions of physiological function (PF), bodily pain (BP), social function (SF), mental health (MH) and total score of SF-36 scale were all significantly lower in the SD group than the control group (P<0.05). After treatment, the total effective rate of treatment was 48.67% (73/150) in the SD group, and the rate was 59.09% (39/66) in the high QOL group, which was obviously higher than that of the low QOL group (40.48%, 34/84, P<0.05). Spearman correlation analysis showed that the total SF-36 score was positively correlated the therapeutic efficacy in the elderly SD patients (r=0.211; P=0.023). Multivariate logistic regression analysis suggested that time from onset to treatment ＞7 d (OR=3.084,95%CI 1.529-9.463), dizziness (OR=2.125,95%CI 1.245-3.629), sleep disorder (OR=4.768,95%CI 2.122-10.713), anxiety (OR=1.923,95%CI 1.330-2.780), type A personality characteristics (OR=5.714,95%CI 1.481-22.053) and acute stress disorder (ASD) (OR=4.191,95%CI 1.518-11.568) were risk factors for poor QOL, and positive coping style (OR=0.389,95%CI 0.200-0.760) was a protective factor in elderly SD patients. Conclusion The QOL is significantly lower in the elderly SD patients than the individuals of same age, and there is a correlation between QOL and therapeutic effect in them. In addition to the necessary interventions, it is recommended to pay more attention to the QOL of the patients, and to improve their QOL during hospitalization in aspects of sleep improvement, emotion regulation, adjustment of coping styles and others.

This work was supported by the “Dengfeng” Talent Training Plan of Beijing Hospital Management Center (DFL20220102).