老年人慢性中耳炎和中耳胆脂瘤的临床特点及围术期处理  

Clinical Characteristics and Perioperative Treatment of Chronic Otitis Media and Middle Ear Cholesteatoma in the Elderly

作　　者：杨文飞[1] 陈伟峰[1] 彭永华 吴雅琴[2] YANG Wen-fei;CHEN Wei-feng;PENG Yong-hua;WU Ya-qin(Department of Otolaryngology-Head and Neck Surgery,the First Affiliated Hospital of Gannan Medical College,Ganzhou 341000,China;Department of Otolaryngology-Head and Neck Surgery,the Sixth People’s Hospital of Shanghai,Shanghai 200233,China)

机构地区：[1]赣南医学院第一附属医院耳鼻咽喉头颈外科,江西赣州341000 [2]上海市第六人民医院耳鼻咽喉头颈外科,上海200233

出　　处：《实用临床医学（江西）》2019年第7期54-58,共5页Practical Clinical Medicine

摘　　要：目的总结老年人慢性中耳炎和中耳胆脂瘤的临床特点及围术期处理的注意事项,为临床诊治提供借鉴。方法回顾分析2017年1月至2019年1月收治的80例≥60岁慢性中耳炎、中耳胆脂瘤患者的术前及术后临床资料。结果80例患者中,流脓71例(88.8%)、听力下降74例(92.5%)、耳鸣33例(41.3%);病程1周~60年,中位数10年;术侧耳气导均值(66.8±22.0)dBHL,气骨导差均值(34.3±13.5)dBHL;合并高血压29例、糖尿病9例、肾衰2例;有手术史22例;动态心电图异常79例,肺功能异常66例,心超异常58例。患者均采取全身静吸复合麻醉,行鼓室成形术者28例(35%),鼓室成形术+乳突根治手术52例(65%)。术后:术区感染7例,术区血肿4例,排尿困难3例,胸闷3例。患者均安全度过围术期。结论老年患者病程长,术前气导平均听阈高、并发症多,应全面评估患者身体状况及机能,并予针对性治疗;术后要严密观察病情变化。多学科共同参与制定围术期干预、处理方案是防范不良事件的良好举措。Objective To summarize the clinical characteristics and attention matters of perioperative management in elderly patients with chronic otitis media and middle ear cholesteatoma,and to provide reference for clinical diagnosis and treatment of the disease. Methods Preoperative and postoperative data of 80 patients(60 years of age or older) treated from January 2017 to January 2019 for chronic otitis media and middle ear cholesteatoma were analyzed retrospectively. Results Among the 80 patients,suppuration occurred in 71(88.8%),hearing loss in 74(92.5%),and tinnitus in 33 cases(41.3%).The median duration of disease was 10 years(range,1 week to 60 years).The mean value of auricular air conduction was(66.8±22.0)dBHL and the mean value of air-bone gap was(34.3±13.5)dBHL.Of these patients,29 had hypertension,9 had diabetes,2 had renal failure,22 had history of surgery,79 had dynamic electrocardiogram abnormalities,66 had pulmonary dysfunctions,and 58 had cardiac ultrasound abnormality.All patients received general intravenous-inhalational anesthesia and safely got through the perioperative period.Tympanoplasty was performed in 28 cases(35%) and tympanoplasty+mastoidectomy were carried out in 52(65%).After operation,7 patients had surgical site infection,4 patients had surgical site hematoma,3 patients had dysuria,and 3 patients had chest tightness. Conclusion The elderly patients have a long course of disease with high preoperative air-conduction hearing threshold and many complications.Therefore,patient’s physical condition and function should be comprehensively evaluated,targeted treatment should be performed,and the condition should be closely observed after operation.Multidisciplinary participation in the formulation of perioperative interventions and treatment schemes is a good measure to prevent adverse events.

关 键 词：慢性中耳炎 中耳胆脂瘤 临床特点 手术治疗 围术期 老年人 

分 类 号：R764.43[医药卫生—耳鼻咽喉科]