徐境　晏丹　潘刚强

[摘要] 目的 探索心理干预在特发性耳鸣治疗中的积极作用，为临床应用提供理论依据。 方法 选取2015年12月～2016年12月黄石爱康医院收治的特发性耳鸣患者66例，采用随机数字表法分为对照组和观察组各33例。两组均行常规治疗（药物治疗、鼓室内注射、高压氧）。此外，观察组联合心理干预（习服、认知、掩蔽、暗示）。所有患者治疗前后分别给予汉密尔顿焦虑量表（HAMA）和抑郁量表（HAMD）评分。分别比较两组患者治疗2周末和治疗结束后2个月的治疗有效率。 结果 组内比较，观察组患者治疗后的HAMA评分与HAMD评分均明显低于治疗前（P < 0.05），而对照组患者治疗前后评分比较，差异无统计学意义（P > 0.05）。组间比较，两组患者治疗前HAMA评分与HAMD评分比较，差异无统计学意义（P > 0.05）；观察组患者治疗后的HAMA评分与HAMD评分明显低于对照组（P < 0.05）。观察组患者治疗2周末和治疗结束后2个月的有效率明显高于对照组（P < 0.05）。 结论 在特发性耳鸣患者的常规治疗中结合习服、认知、掩蔽、暗示心理干预手段，可以明显的改善患者的焦虑抑郁情绪，提高治疗效果。

[关键词] 特发性耳鸣；心理干预；临床疗效

[中图分类号] R76 [文献标识码] A [文章编号] 1673-7210（2017）09（c）-0124-04

[Abstract] Objective To investigate the role of psychological intervention in treatment of idiopathic tinnitus and provide the theoretical basis for clinical application. Methods From December 2015 to December 2016， 66 patients with idiopathic tinnitus in Huangshi Love & Health Hospital were selected and divided into control group and observation group by random number table， with 33 cases in each group. Both groups were treated by routine treatment （drug therapy， intratympanic injection， hyperbaric oxygen）. Additionally， the observation group was combined with psychological intervention （acclimatization， cognitive， masking， implied）. Hamilton anxiety scale （HAMA） and Hamilton depression scale （HAMD） examinations were taken before and after treatment. The effective rates of two groups were compared at the end of 2-week treatment and 2 months after treatment，respectively. Results In observation group， the HAMA score and HAMD score after treatment were lower than those before treatment （P < 0.05）. But there was no significant difference in control group （P > 0.05）. Before treatment， there was no difference in HAMA score and HAMD score between two groups （P > 0.05）. After treatment， the HAMA score and HAMD score in the observation group were significantly lower than those in the control group （P < 0.05）. The effective rate of the observation group was significantly higher than that of the control group both at the end of 2-week treatment and 2 months after treatment （P < 0.05）. Conclusion Psychological intervention in the conventional treatment of idiopathic tinnitus can reduce anxiety and depression and improve therapeutic effect.

[Key words] Idiopathic tinnitus； Psychological intervention； Clinical efficacy

耳鸣是指在无任何外界刺激或相应声源的情況下所产生的异常声音感觉，病因和发病机制至今尚未清楚，是临床诊疗的重点和难题。特发性耳鸣是指通过目前的检查手段（包括耳及全身的体格检查、听力学检查、实验室检查以及影像学检查等）未发现有明显的器质性病变，或异常检查的结果与耳鸣的发生没有确切因果关系[1-2]。近年来随着年龄的增长，生活节奏的加快，工作压力增大，耳鸣发病率呈现直线上升趋势。对耳鸣错误的认知、反感态度对它赋予负面的意义，产生焦虑、紧张、恐惧、抑郁、睡眠障碍等心理障碍，这些都可能过度激活大脑情绪系统，使其发展为痛苦性耳鸣[3-4]。因此……