术前耳分泌物对慢性化脓性中耳炎和中耳胆脂瘤术后干耳的影响
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摘要
目的:探讨术前耳分泌物对慢性化脓性中耳炎和中耳胆脂瘤术后干耳时间和干耳率的影响。方法:收集228例接受开放式乳突改良根治术、鼓室成形术治疗的慢性化脓性中耳炎和中耳胆脂瘤患者,以术侧耳内有无分泌物及分泌物微生物类型为变量,分析术后干耳时间和干耳率。结果:不同术前耳内分泌物微生物类型患者间术后干耳时间比较差异有统计学意义(P<0.05)。经分组检验,无分泌物组干耳时间为(2.24±1.83)个月,口腔及皮肤正常菌群组为(2.22±1.96)个月,单一非耐药菌组干耳时间为(3.00±2.51)个月,真菌组为(3.82±2.78)个月,复合菌群或多重耐药菌组为(6.82±1.83)个月。复合菌群或多重耐药菌组干耳时间明显长于其他组(P<0.05);真菌组干耳时间长于单一非耐药菌、口腔及皮肤正常菌群和无分泌物组(P<0.05)。经χ~2检验显示,不同术前分泌物分类的患者术后干耳率整体差异有统计学意义(P<0.05)。结论:术前耳内有无分泌物及微生物类型是术后干耳时间和干耳率的一个重要影响因素。针对术前分泌物进行微生物培养及药敏实验,并根据结果用药有助于慢性化脓性中耳炎和中耳胆脂瘤患者的术后恢复。
Objective:To investigate the influences of preoperative secretions of the patients with chronic suppurative otitis media and/or middle ear cholesteatoma on the time to have dry ears after the operations.Method:The study enrolled 228 patients with chronic suppurative otitis media and/or middle ear cholesteatoma who received modified radical mastoidectomies and tympanoplasty.The patients were divided into two groups based on whether there were secreions in the surgical ear before the operations.The time to have dry ears after surgeries were compared between the two groups.Result:The time to have dry-ear postoperatively was significantly different between patients with different preoperative microbial types of surgical ear secretions(P<0.05).The dry ear time was(2.24±1.83)months in the secretion-free group,(2.22±1.96)months in the normal bacteria group of oral cavity and skin,(3.00±2.51)months in the single non-resistant bacteria group,(3.82±2.78)months in the fungal group and(6.82±1.83)months in the compound or multi-drug resistant bacteria group.The dry ear time of compound bacteria group or multi-drug resistant bacteria group was significantly longer than that of the other groups(P<0.05).The time to have dry ears of the fungus group was longer than that of the non-drug resistant bacteria,the normal oral and skin flora and the secretion free group(P<0.05).Chi-square test results showed that there was a significant difference in postoperative dry ear rate among patients with different preoperative secretions classification(P<0.05).Conclusion:The presence of secretion and microorganism type in ear before operation is an important influencing factor of postoperative time to have dry ears.Microbiological culture and appropriate medication based on the drug sensitivity tests are beneficial for the postoperative recovery of patients with chronic suppurative otitis media and/or middle ear cholesteatoma.
Objective:To investigate the influences of preoperative secretions of the patients with chronic suppurative otitis media and/or middle ear cholesteatoma on the time to have dry ears after the operations.Method:The study enrolled 228 patients with chronic suppurative otitis media and/or middle ear cholesteatoma who received modified radical mastoidectomies and tympanoplasty.The patients were divided into two groups based on whether there were secreions in the surgical ear before the operations.The time to have dry ears after surgeries were compared between the two groups.Result:The time to have dry-ear postoperatively was significantly different between patients with different preoperative microbial types of surgical ear secretions(P<0.05).The dry ear time was(2.24±1.83)months in the secretion-free group,(2.22±1.96)months in the normal bacteria group of oral cavity and skin,(3.00±2.51)months in the single non-resistant bacteria group,(3.82±2.78)months in the fungal group and(6.82±1.83)months in the compound or multi-drug resistant bacteria group.The dry ear time of compound bacteria group or multi-drug resistant bacteria group was significantly longer than that of the other groups(P<0.05).The time to have dry ears of the fungus group was longer than that of the non-drug resistant bacteria,the normal oral and skin flora and the secretion free group(P<0.05).Chi-square test results showed that there was a significant difference in postoperative dry ear rate among patients with different preoperative secretions classification(P<0.05).Conclusion:The presence of secretion and microorganism type in ear before operation is an important influencing factor of postoperative time to have dry ears.Microbiological culture and appropriate medication based on the drug sensitivity tests are beneficial for the postoperative recovery of patients with chronic suppurative otitis media and/or middle ear cholesteatoma.
引文
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[5]刘勇,李娜.术前病菌感染、咽鼓管功能障碍与慢性化脓性中耳炎患者术后不干耳的相关性[J].中国临床研究,2018,31(1):47-50.
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[2]廖剑绚,刘洁.慢性化脓性中耳炎术后不干耳的原因与处理[J].现代医药卫生,2014,30(17):2615-2616.
[3]张群慧.慢性化脓性中耳炎术后不干耳的相关因素分析[J].白求恩医学杂志,2015,13(4):416-417.
[4]高芬琦,王林娥,龚树生,等.开放式乳突根治术后不干耳原因分析[J].临床耳鼻咽喉头颈外科杂志,2018,32(7):530-533.
[5]刘勇,李娜.术前病菌感染、咽鼓管功能障碍与慢性化脓性中耳炎患者术后不干耳的相关性[J].中国临床研究,2018,31(1):47-50.
[6]SEO Y,NONAKA M,TAGAYA E,et al.Eosinophilic otitis media is associated with asthma severity and smoking history[J].ORL J Otorhinolaryngol Relat Spec,2015,77:1-9.
[7]ERDIVANLI O C,COSKUN Z O,KAZIKDAS K C,et al.Prevalence of Otitis Media with Effusion among Primary School Children in Eastern Black Sea,in Turkey and the Effect of Smoking in the Development of Otitis Media with Effusion[J].Indian J Otolaryngol Head Neck Surg,2012,64:17-21.
[8]王芳,胡晓艳,姜梁.慢性化脓性中耳炎病原学特点及术后不干耳影响因素分析[J].医学临床研究,2017,34(3):486-489.
[9]付健,孔祥云,樊军.慢性化脓性中耳炎患者真菌感染的临床分析[J].中华医院感染学杂志,2014,24(8):2008-2010.
[10]张坤,付涛,贾楠.慢性中耳炎合并鲍氏不动杆菌感染的临床特点分析[J].临床耳鼻咽喉头颈外科杂志,2016,30(23):1885-1887.
[11]官文君,李朝军.慢性化脓性中耳炎细菌学研究进展[J].重庆医学,2015,44(6):842-844.
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