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  

Pathogenic Analysis of Chronic Suppurative Otitis Media and the Influencing Factors of Non-dry Ear after Surgery

作　　者：王芳[1] 胡晓艳 姜梁 

机构地区：[1]成都医学院第二附属医院·核工业四一六医院耳鼻喉科,四川成都610051 [2]西南医科大学病原生物学教研室,四川泸州646000 [3]西南医科大学附属医院耳鼻咽喉头颈外科,四川泸州646000

出　　处：《医学临床研究》2017年第3期486-489,共4页Journal of Clinical Research

摘　　要：[目的]分析慢性化脓性中耳炎病原学特点以及术后不干耳发生的影响因素，为提高慢性化脓性中耳炎治愈率，减少并发症提供依据。[方法]选取2013年1月至2015年i月于本科室行慢性化脓性中耳炎手术治疗的243例患者为研究对象，对中耳腔分泌物进行病原学监测，分析病原菌分布及药物敏感性；将患者分为干耳组和不干耳组，统计分析年龄、性别、吸烟嗜酒史、基础疾病、营养状况、实验室检查结果等临床资料，对术后不干耳危险因素做出评价。[结果]255耳脓液标本中有213耳检出病原菌，检出率为83．5％；共检出病原菌268株，其中革兰阳性（G^＋）病原菌为154株占总数57．5％，革兰阴性（G^-）菌92株占34．3％，真菌22株，占8．2％。药敏试验显示，G^+菌葡萄球菌对糖肽类抗生素敏感；G^-菌对多粘菌素B、碳青霉烯类抗生素敏感；真菌对抗真菌药均敏感。术后不干耳与吸烟、患糖尿病及真菌感染（特别是毛霉菌感染）相关，两组差异具有统计学意义（P〈0．05）。[结论]对慢性化脓性中耳炎的治疗，应根据患耳分泌物病原学特点选用敏感抗生素，要重视真菌感染可能性，还应力劝患者戒烟并严格控制血糖。[Objective]To analyze the pathogen characteristics of chronic suppurative otitis media and postoperative factors affecting of occurance of nowdry ear in order to improve the cure rate of chronic suppurative otitis media and provide a basis to reduce the complications.[Methods]A total of 243 patients who were treated with surgery for chronic sup- purative otitis media in our hospital from Jan 2013 to Jan 2015 were included in this study. Etiology monitoring was con- ducted on the middle ear cavity discharge , and analysis was carried out on pathogenic bacterial distribution and drug sen sitivity;The patients were divided into dry ear group and non-dry ear group; statistical analysis was made on age, gender, smoking, alcohol abuse, basic disease, nutritional status, clinical data and laboratory results; the postoperative risk fac tots of non-dry ear were evaluated.[Results] Pathogenic bacteria was detected in 213 of 255 ear pus samples, the detection rate was 83.5%; A total of 268 strains of pathogens were detected , including 154 Grampositive bacteria which accoun ted for 57.5% of total pathogens, and 92 Gram negative ones which accounted for 34.3%; and 22 fungi ones accounting for 8.2%. Drug sensitive tests showed that Grampositive bacteria was sensitive to glycopeptide antibiotics , and the Gram negetive was sensitive to polymyxin B and carbapenems; Fungi was sensitive to antifungal drug. Non-dry ear after surgery was associated with smoking, diabetes and fungal infections （especially mucormycosis related）, the difference of the two groups was statistically significant （ P 〈0.05）.[Conclusion]The treatment of chronic suppurative otitis media should be based on sensitive antibiotic. Attention should be paid to the possibility of fungal infection, and patients are strongly advised to stop smoking and strictly control blood sugar.

关 键 词：中耳炎 化脓性 慢性病 微生物敏感性试验 细菌 手术后并发症 危险因素 

分 类 号：R764.21[医药卫生—耳鼻咽喉科]