地塞米松辅助鼓室成形术治疗慢性化脓性中耳炎患者的疗效及预后因素分析  

Analysis of efficacy and prognostic factors in chronic suppurative otitis media treated with dexamethasone-assisted tympanoplasty

作　　者：韩利芳 赵静[1] 于晓宇 方蝶 HAN Lifang;ZHAO Jing;YU Xiaoyu;FANG Die(Department of Otolaryngology Head and Neck Surgery,Hangzhou First People's Hospital,Hangzhou 310000,China)

机构地区：[1]杭州市第一人民医院耳鼻咽喉头颈外科,杭州310000

出　　处：《药学前沿》2025年第4期601-608,共8页China Pharmacist

基　　金：浙江省医药卫生科技计划项目(2025KY1036)。

摘　　要：目的分析地塞米松辅助耳内镜鼓室成形术后治疗慢性化脓性中耳炎(CSOM)患者的疗效及预后影响因素。方法回顾性分析2019年5月—2024年5月在杭州市第一人民医院就诊的CSOM患者临床资料,根据术后是否辅助使用地塞米松分为对照组(未使用地塞米松)和观察组(使用地塞米松),比较两组治疗效果。根据全部患者术后6个月的听力恢复情况分为疗效良好组和疗效不良组,多因素Logistic回归分析术后疗效不良的影响因素,通过R软件构建列线图预测模型,利用受试者工作特征(ROC)曲线及其曲线下面积(AUC)评估模型的预测效能。结果共纳入96例患者,其中观察组50例,对照组46例。观察组治疗总有效率显著高于对照组(80.00%vs.54.35%,P<0.05)。多因素Logistic回归分析显示,听骨链病变[OR=2.784,95%CI(1.388,5.583)]、无鼓膜张肌腱[OR=2.765,95%CI(1.211,6.310)]、镫骨仅剩底板[OR=2.680,95%CI(1.449,4.960)]、术后未辅助使用地塞米松[OR=2.776,95%CI(1.200,6.423)]是CSOM患者鼓室成形术后预后不良的独立影响因素。构建的列线图AUC为0.932,校准曲线显示其预测概率与实际发生率具有较好的一致性。决策曲线分析表明,当风险阈值为0.691时,使用该列线图模型可获得较未使用模型更高的临床净获益。结论CSOM患者鼓室成形术后采用地塞米松辅助治疗能有效改善听力,听骨链病变、镫骨仅剩底板、无鼓膜张肌腱可能与预后不良有关。Objective To analyze the efficacy and prognostic factors of dexamethasone in the treatment of patients with chronic suppurative otitis media(CSOM)after endoscopic tympanoplasty.Methods The clinical data of patients with CSOM in Hangzhou First People's Hospital from May 2019 to May 2024 were retrospectively analyzed.According to whether dexamethasone was used after surgery,the patients were divided into a control group(without dexamethasone)and an observation group(with dexamethasone).The treatment effects were compared between the two groups.According to the hearing recovery of all patients at 6 months after surgery,they were divided into a good efficacy group and a poor efficacy group.The influencing factors of poor postoperative efficacy were analyzed by multilogistic multifactorial regression,the predictive model of the nomogram was constructed by R software,and the receiver operating characteristic(ROC)curve and its area under the curve(AUC)were used to evaluate the predictive efficiency of the model.Results A total of 96 patients were included,with 50 in the observation group and 46 in the control group.The total effective rate of the observation group was significantly higher than that of the observation group(80.00%vs.54.35%,P<0.05).The results of multifactorial Logistic regression showed that lesions of the auditory chain[OR=2.784,95%CI(1.388,5.583)],absence of tympanic tensor fasciae latae tendon[OR=2.765,95%CI(1.211,6.310)],stapes with only the base plate[OR=2.680,95%CI(1.449,4.960),]and not using adjuvant dexamethasone after the surgery[OR=2.776,95%CI(1.200,6.423)]were independent influencing factors on poor postoperative outcomes of CSOM.The AUC of the constructed nomogram demonstrated was 0.932.The calibration curve indicated a satisfactory agreement between predicted probabilities and actual outcomes.Decision curve analysis revealed that at a risk threshold of 0.691,the clinical net benefit derived from using the nomogram exceeded that of not applying the model.Conclusion The use of dexamethasone ad

关 键 词：慢性化脓性中耳炎 地塞米松 耳内镜鼓室成形术 手术疗效 影响因素 预测模型 

分 类 号：R764.21[医药卫生—耳鼻咽喉科]