鼓室内注射布地奈德治疗12岁以上儿童及成人分泌性中耳炎的长期疗效分析

发布时间：2018-05-25 01:40

本文选题：中耳炎 + 伴渗出液　；参考：《临床耳鼻咽喉头颈外科杂志》2017年16期

【摘要】：目的:研究鼓室内注射布地奈德(BUD)治疗12岁以上儿童及成人分泌性中耳炎(OME)患者的长期疗效及对主观症状的改善情况。方法:将180例OME患者按照单盲、随机、平行对照原则分为BUD组、地塞米松注射液组(DEX对照组)和0.9%NaCl溶液组(NS对照组),分别行鼓室内注射BUD(0.5 mg/ml)、DEX(5mg/ml)、NS(1ml),每周1次,同时记录每次治疗情况和患者主观症状评分,直至治愈或退出,治疗结束后随访3年。使用生存曲线图分析3组患者疗效差别,使用视觉模拟评分法(VAS)比较3组患者主观症状改善程度。结果:在控制了病程、抽出液体体积与抽出液体性状及其他因素的作用后,治疗方式为BUD组的患者治疗结果无效或复发的危险性是NS对照组患者的0.131倍(95%CI 0.053-0.354)。生存曲线示BUD组96.6%(57/59)的患者有效保持时间为3个月以上,83.1%(49/59)的患者有效保持时间为1年以上,81.4%(48/59)的患者有效保持时间为3年以上;DEX对照组73.2%(41/56)的患者有效保持时间为3个月以上,46.4%(26/56)的患者有效保持时间为1年以上,42.9%(24/56)的患者有效保持时间为3年以上;NS对照组50.8%(33/65)的患者有效保持时间为3个月以上,26.2%(17/65)的患者有效保持时间为1年以上,20.0%(13/65)的患者有效保持时间为3年以上。3种药物鼓室内注射对于OME的纵向疗效从高到低依次为BUD、DEX、NS(P0.05)。BUD组在改善耳闷症状方面优于DEX组和NS组,同时前两者改善主观症状和提高生活质量方面均优于NS组(P0.05)。试验过程中未出现严重并发症及后遗症。结论:鼓室内注射BUD是治疗12岁以上儿童及成人OME患者长期、有效和安全的治疗方法。
[Abstract]:Objective: to study the long-term curative effect of budesonide bud injection in the treatment of patients with secretory otitis media (OMEE) over 12 years old and the improvement of subjective symptoms. Methods: 180 patients with OME were divided into BUD group, dexamethasone injection group and 0.9%NaCl solution group according to the principle of single blind, random and parallel control. At the same time, every time treatment and subjective symptom score were recorded, until cured or withdrawn, followed up for 3 years after treatment. Survival curve was used to analyze the difference of curative effect among the three groups and visual analogue score (VAS) was used to compare the degree of improvement of subjective symptoms in the three groups. Results: after controlling the course of disease, the volume of fluid extracted, the character of fluid extraction and other factors, the risk of ineffectiveness or recurrence of treatment results in BUD group was 0.131 times of that in NS control group (CI 0.053-0.354). The survival curve showed that the effective retention time of the patients in the BUD group was more than 3 months, 83.1% and 49% 59) in the BUD group, the effective retention time was more than one year, 81.4% and 48 / 59.) the effective retention time in the BUD group was more than 3 years, and the effective retention time in the DEX control group was 73.2% 41 / 56). The effective retention time of the patients in the NS control group is more than 3 years. The effective retention time of the patients in the NS control group is more than 3 months, the effective retention time in the patients with 26 / 56 / 26 / 56 is more than one year, and the effective retention time is more than 20. 0 / 13 / 65 in the NS control group. The effective retention time of the patients was more than 3 years. The longitudinal effect of intratympanic injection of 3 drugs on OME was higher than that of DEX group and NS group. At the same time, the former two groups were better than NS group in improving subjective symptoms and quality of life (P 0.05). There were no serious complications and sequelae in the course of the trial. Conclusion: Intratympanic injection of BUD is a long term, effective and safe method for the treatment of OME in children and adults over 12 years of age.
【作者单位】：成都上锦南府医院耳鼻喉科;四川大学华西医院耳鼻咽喉头颈外科;遂宁市中心医院耳鼻喉科;
【分类号】：R764.21

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