高龄及合并全身疾病慢性化脓性中耳炎患者围手术期管理  

Perioperative management of chronic suppurative otitis media patients with aging and systematic diseases

作　　者：崔彪[1,2] 时海波[1] 吴雅琴[1] 陈正侬[1] 杨诗垠 周慧群[1] 殷善开[1] 

机构地区：[1]上海交通大学附属第六人民医院耳鼻咽喉头颈外科,上海200240 [2]上海市浦东新区人民医院耳鼻咽喉科,上海200233

出　　处：《中国耳鼻咽喉颅底外科杂志》2016年第5期365-369,共5页Chinese Journal of Otorhinolaryngology-skull Base Surgery

基　　金：上海交通大学医学院"研究型医师-高原高峰计划"(20152233);上海市卫生计划生育委员会"新百人计划"(XBR2013085)

摘　　要：目的手术治疗高龄或伴全身疾病的慢性化脓性中耳炎患者时，手术风险及手术相关并发症的发生率相对较高。本文分析了此类患者的基础疾病特点及管理原则，以期更好地维护围手术期安全，为存在相对手术禁忌的患者提供治愈机会。方法2009年1月-2015年1月我科收治拟行手术治疗的高龄或伴全身疾病慢性化脓性中耳炎患者268例，根据基础疾病的类型、严重程度、治疗用药对手术的影响等进行围手术期管理，排除手术禁忌并决定是否建议手术。根据手术实施率、基础疾病恶化率、干耳率等评估围手术期管理的合理性。结果268例患者中，6例因无法控制基础疾病而放弃手术，余262例接受手术，手术实施率为97．8％。所有手术患者中，术前91例（34．7％）需要调整基础疾病治疗方案；术后14例（5．3％）出现基础疾病恶化，包括7例血糖紊乱、4例血压紊乱、1例诱发谵妄、1例哮喘复发、1例再发脑梗，余248例（94．7％）术后平稳。所有手术患者均实现干耳，未出现面瘫、感音神经性耳聋等手术相关并发症。结论针对各不同类型基础疾病，采用相应的干预措施，有望为存在相对手术禁忌的慢性化脓性中耳炎患者获得治愈机会，降低围手术期严重并发症的发生几率。Objective Surgical treatment for suppurative otitis media in patients with aging and systematic diseases usually means high risk of complications during perioperative period. This study is to explore the features of patients＇ basic diseases, management principle, in order to acquire a well maintenance of the surgical safety and cure opportunity for those with relative contraindications. Methods From Jan. 2009 to Jan. 2015, 268 cases of chronic suppurative otitis media with aging and combined with basic diseases were hospitalized for preoperative preparation at our department. Based on pattern and severity of the systematic diseases, and effect of perioperative medication on the operative process and postoperative complications, individualized perioperative managements were performed. The rates of reasonable surgical practice, disease progression, as well as dry ears were used to evaluate the efficacy of the perioperative management. Results Among 268 cases, 6 did not receive operation due to their basic diseases out of control and the rest 262 received operation with an implementation rate of 97.8%. Of all the operated patients, 91 cases （91/262, 34.7% ） required re-control of basic disease before operation. After operation, the basic diseases got worsen in 14 cases （ 14/262, 5.3% ）, including disorder of blood glucose in 7, disorder of blood pressure in 4, postoperative delirium in one, asthmatic attack in one, and cerebral re-infarction in one. All patients acquired dry ears and there was no case experiencing operation-related peripheral facial paralysis or sensorineural deafness after operation. Conclusion The relevant measures based on the different patterns of basle diseases may help to provide a cure opportunity for chronic suppurative otitis media patients in bad situations and to decrease the rate of severe complications during perioperative period.

关 键 词：慢性化脓性中耳炎 高龄 全身疾病 围手术期管理 

分 类 号：R764.92[医药卫生—耳鼻咽喉科]