鼓膜置管术后通气管阻塞的因素分析以及应对策略  

Analysis and treatment of postoperative blockage of tympanic ventilation tubes

作　　者：舒易来[1] 李庆忠[1] 李华伟[1] 

机构地区：[1]复旦大学附属眼耳鼻喉科医院耳鼻咽喉科国家卫计委听觉医学重点实验室上海市听觉医学临床中心,上海200031

出　　处：《临床耳鼻咽喉头颈外科杂志》2017年第9期697-699,共3页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

基　　金：国家自然科学基金(No:NSFC81300824);上海市浦江人才资助项目(No:15PJ1401000)

摘　　要：目的:研究鼓膜置管术后通气管阻塞的危险因素以及相应的应对措施。方法:回顾性分析2010-02-2015-02期间行鼓膜置管的145例患者(198耳),术后未滴药;以及2015-03-2016-02期间行鼓膜置管的59例患者(80耳),该组术后均给予氧氟沙星滴耳液。分别在术后1、3、6、12个月随访,检查通气管的位置,是否有阻塞发生。如发现干痂、耵聍或血痂阻塞,应用4%碳酸氢钠滴耳液滴耳后清理,根据清理结果和是否再次出现积液情况,采取随访或再次置入新的通气管。对于有脓性分泌物的患者,给予3%双氧水和氧氟沙星滴耳液,使通气管再通。结果:在未滴药的145例(198耳)中,共有16例患者出现通气管阻塞,其中管腔内干痂阻塞8例,血痂阻塞或覆盖通气管3例,耵聍阻塞3例,脓性分泌物2例。滴药的59例患者中,共有7例出现通气管阻塞,其中管腔内干痂阻塞1例,血痂阻塞或覆盖通气管1例,耵聍阻塞4例,脓性分泌物1例。结论:鼓膜置管术后通气管阻塞较为常见,术中、术后可进行预防和处理,术后短期抗生素滴耳可以有效预防通气管阻塞和术后感染的发生。Objective：To explore the occurrence and treatment of complications of postoperative blockage of tympanic ventilation tubes.Method：Two hundred and four patients（278 ears）with otitis media with effusion（OME）who received tympanostomy tube insertion from February 2010 to February 2016 were retrospectively analyzed.Ofloxacin ear drops was introduced into 80 ears in 59 patients undergoing myringotomy and ventilation tube insertion.In a follow-up period of 1,3,6,12 months,if the blockage is caused by viscid secretion,blood clot or cerumen,4% of sodium bicarbonate ear drops were used to treat patients.3% aquae hydrogenii dioxidi and Ofloxacin ear drops were used on the patients with purulent otorrhea.Result：In the 198 ears without Ofloxacin ear drops treatment,postoperative tube obstruction occurred in 16 ears（8 of viscid secretion,3 of blood clot,3 of cerumen and 2 of purulent otorrhea）.Of the 59 patients who received Ofloxacin ear drops treatment,seven ears experienced blocked tubes（1 of viscid secretion,1 of blood clot,4 of cerumen and 1 of purulent otorrhea）.Conclusion：The complication of postoperative blockage of tympanic ventilation tubes is common.Relative prevention and therapy should be performed during intraoperative and postoperative procedures.Short term treatment of Ofloxacin ear drops can prevent postoperative blockage of tympanic ventilation tubes and infection.

关 键 词：中耳炎 伴渗出液 鼓膜置管 通气管阻塞 

分 类 号：R764.9[医药卫生—耳鼻咽喉科]