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  

Correlation between preoperative pathogenic bacteria infection,eustachian tube dysfunction and postoperative wet ear in patients with chronic suppurative otitis media

作　　者：刘勇[1] 李娜 

机构地区：[1]陕西中医药大学第二附属医院耳鼻咽喉头颈外科,陕西咸阳712000 [2]陕西省核工业二一五医院功能科,陕西咸阳712000

出　　处：《中国临床研究》2018年第1期47-50,55,共5页Chinese Journal of Clinical Research

基　　金：陕西省社会发展科技攻关项目(2015SF234)

摘　　要：目的研究慢性化脓性中耳炎实施显微手术治疗的患者术前病菌感染、咽鼓管功能障碍与术后不干耳的相关性。方法采用回顾性研究方法,选取2015年11月至2016年12月慢性化脓性中耳炎患者91例,均为单侧发病,均于入院时实施显微手术治疗。依据术后是否发生不干耳分为A组(术后干耳)69例,B组(术后不干耳)22例,两组均行病原学培养及药敏测定。统计比较两组患者一般资料(性别、年龄、病程、吸烟史)和临床资料(鼻咽部炎症、术前病菌感染、中耳炎类型、外耳道口狭窄、咽鼓管功能)。采用Logistic回归分析慢性化脓性中耳炎患者术后不干耳的危险因素,采用Spearman分析病菌感染、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。结果 91例(91耳)患者鼓室内脓液中有29耳检测出致病菌,检出率为31.87%;共检测出致病菌134株,其中真菌11株,占8.21%,革兰阴性菌47株,占35.07%,革兰阳性菌76株,占56.72%。B组吸烟史、术前病菌感染、外耳道口狭窄、咽鼓管功能障碍发生率均高于A组,差异有统计学意义(P<0.05,P<0.01)。Logistic回归分析显示,吸烟史、术前病菌感染、外耳道口狭窄、咽鼓管功能障碍均为慢性化脓性中耳炎患者术后不干耳发病的影响因素(P<0.05,P<0.01);Spearman相关性分析显示,术前病菌感染(r=0.783,P=0.007)、咽鼓管功能障碍(r=0.724,P=0.012)与慢性化脓性中耳炎患者术后不干耳呈正相关。结论术前病菌感染、咽鼓管功能障碍均为慢性化脓性中耳炎患者术后不干耳发生的独立危险因素,且与其术后不干耳呈正相关,临床中应极力消除或减少此类危险因素,进而有效预防慢性化脓性中耳炎患者术后不干耳。Objective To investigate the relationship between preoperative infection of pathogenic bacteria, eustachian tube dysfunction and postoperative wet ear in patients with chronic suppurative otitis media undergoing microsurgery. Methods Using the method of retrospective study, 91 patients with unilateral chronic suppurative otitis media between November 2015 and December 2016 were selected. Microsurgery was performed at admission in all patients. According to whether there was postoperative wet ear,the patients were divided into group A （postoperative dry ear,n =69） and group B （postoperative wet ear,n =22）. Pathogen culture and drug sensitivity test were performed in both two groups. The general information （Sex, age, duration of disease and smoking history） and the clinical data （inflammation of nasopharynx, preoperative pathogenic bacteria infection, types of otitis media, stenosis of the opening of external auditory canal and eustachian tube function） were compared between two groups. Logistic regression analysis was used to analyze the risk factors of postoperative wet ear in patients with chronic suppurative otitis media. Spearman analysis was used to analyze the correlation between preoperative pathogenic bacteria infection, eustachian tube dysfunction and postoperative wet ear in patients with chronic suppurative otitis media. Results The pathogenic bacteria were detected in tympanic cavity pus fluid of 29 ears in 91 cases （91 ears）, thus the check out rate was 31.87%. A total of 134 strains of pathogenic bacteria including 11 strains of fungi （8.21%） ,47 strains of gram negative bacteria （35.07%） and 76 strains of gram positive bacteria （56.72%） were checked out. The incidences of smoking history, preoperative pathogenic bacteria infection, stenosis of external auditory canal opening and eustachian tube dysfunction in group B were higher than those in group A （P 〈 0.05, P 〈 0.01 ）. Logistic regression analysis showed that smoking history, preoperative pathogenic bacte

关 键 词：中耳炎 化脓性 慢性 显微手术 病菌感染 术前 咽鼓管功能障碍 不干耳 术后 

分 类 号：R764.21[医药卫生—耳鼻咽喉科]