白蛋白治疗外伤性鼓膜穿孔的疗效观察

发布时间：2018-11-11 09:33

【摘要】：目的:通过局部外用白蛋白治疗外伤性鼓膜穿孔,观察其临床疗效,探寻一种简单、安全、有效、便捷的治疗外伤性鼓膜穿孔的方法,并使之得到临床推广应用。方法:选取2015年10月至2017年1月在延安大学附属医院耳鼻喉科门诊或住院确诊为外伤性鼓膜穿孔患者80例,男31例,女49例;年龄6~60岁,中位年龄32(11)岁,左耳54例,右耳26例。将外伤性鼓膜穿孔的就诊患者按就诊奇、偶顺序随机分为处理组(n=40)和对照组(n=40),根据鼓膜穿孔的大小又将处理组和对照组分别分为最大直径3mm的小穿孔组、最大直径3~5mm的中穿孔组、最大直径5mm的大穿孔组三个小组[1],处理组给予直接局部外用白蛋白治疗,隔天上1次药,记录耳内镜资料并保存;对照组采用传统干燥法,每3天来院随访1次;两组均口服消炎药,连服3天,保持咽鼓管通畅,患耳勿入水、保持干燥,避免用力擤鼻,以防感染,并预防感冒。入组患者均随访观察2月,观察并记录鼓膜愈合情况,愈合时间、听力增益以及有无感染等并发症发生。疗效评定标准[2]:愈合:鼓膜穿孔完全愈合,愈合鼓膜色泽、形态与正常鼓膜接近,听力恢复正常;好转:鼓膜穿孔缩小,愈合不完全,听力部分改善;无效:穿孔未见明显变化,听力改善不明显。结果:1.白蛋白治疗外伤性鼓膜穿孔,穿孔愈合鼓膜与正常鼓膜极为相似,透明度可,无疤痕。2.两组1个月与2个月的穿孔总愈合率:外伤性鼓膜穿孔1个月时,处理组总愈合率为57.5%(23/40),对照组总愈合率为30%(12/40),差异有统计学意义(P0.05);2个月时处理组总愈合率为85.0%(34/40),对照组总愈合率为55.0%(22/40),差异有显著的统计学意义(P0.01)。据穿孔大小:处理组中穿孔与大穿孔1个月时愈合率分别为66.7%和30.0%,对照组分别为16.7%和0,经统计学检验差异有统计学意义(P0.05);中、大穿孔2个月时处理组愈合率为83.3%和70.0%,对照组为33.3%和12.5%,经统计学检验差异均有统计学意义(P0.05);处理组1个月时小穿孔愈合率为66.7%,对照组小穿孔为50%;处理组2个月时小穿孔愈合率为94.4%,同期对照组为85.0%,经统计学检验差异均无统计学意义(P0.05)。3.两组平均愈合时间差异:小、中、大穿孔组处理组平均愈合时间均明显较对照组缩短,差异有统计学意义(P0.05)。4.听力增益情况:两组患者治疗前平均听阈无统计学差异(P0.05),但鼓膜穿孔愈合后,两组平均听阈差异有统计学意义(P0.05),对照组平均听阈较处理组高,提示:白蛋白治疗有益于外伤性鼓膜穿孔听力症状的恢复。结论:1.白蛋白能显著促进外伤性鼓膜穿孔的愈合,提高愈合率,明显缩短愈合时间,且愈合后鼓膜透明度接近正常鼓膜,治疗后与受伤前听力基本一致。2.白蛋白可作为治疗外伤性鼓膜穿孔经济、简便、安全、疗效确切的方法在临床上推广,不但可以减轻患者经济负担,也可避免了行手术给患者带来较大的创伤,并且该技术还可在基层医院推广普及。
[Abstract]:Objective: to explore a simple, safe, effective and convenient method for the treatment of traumatic tympanic membrane perforation by local administration of albumin in the treatment of traumatic tympanic membrane perforation. Methods: from October 2015 to January 2017, 80 patients (31 males and 49 females) with traumatic tympanic membrane perforation were selected from Otolaryngology, Department of Otorhinolaryngology, affiliated Hospital of Yan'an University. The median age was 32 (11) years, 54 cases of left ear and 26 cases of right ear. Patients with traumatic tympanic membrane perforation were randomly divided into two groups according to odd and even-even order: treatment group (nn 40) and control group (n 40). According to the size of tympanic membrane perforation, the treated group and the control group were divided into two groups: small perforation group with maximum diameter 3mm. The middle perforation group with the maximum diameter 3~5mm and the large perforation group with the largest diameter 5mm [1] were treated with direct local topical albumin therapy. The data of ear endoscopy were recorded and preserved once every other day. The patients in the control group were followed up every 3 days by traditional drying method, and the two groups were given anti-inflammatory drugs for 3 days to keep the eustachian tube open, keep the ear dry, keep dry, avoid blowing your nose forcefully to prevent infection and prevent colds. All the patients were followed up for 2 months. The healing of tympanic membrane, healing time, hearing gain and infection were observed and recorded. Curative effect evaluation standard [2]: healing: the tympanic membrane healed completely, the color of the healing tympanic membrane was close to the normal tympanic membrane, the hearing recovered to normal, the improvement: the tympanic membrane perforation was reduced, the healing was incomplete, the hearing was partly improved; Invalid: there was no obvious change in perforation and no significant improvement in hearing. The result is 1: 1. Albumin treatment of traumatic tympanic membrane perforation, perforation healing tympanic membrane and normal tympanic membrane very similar, transparency can, no scar. 2. The total healing rate of the two groups was 57.5% (23 / 40) at 1 month after traumatic tympanic membrane perforation and 30% (12 / 40) in the control group (P0.05). At 2 months, the total healing rate of the treatment group was 85.0% (34 / 40), while that of the control group was 55.0% (22 / 40). The difference was statistically significant (P0.01). According to the size of perforation: the healing rate of perforation and large perforation was 66.7% and 30.0% in treatment group and 16.7% and 0 in control group respectively. The difference was statistically significant (P0.05). The healing rate of the treatment group was 83.3% and 70.0% after 2 months of large perforation, while that of the control group was 33.3% and 12.5%, the difference was statistically significant (P0.05). The healing rate of small perforation was 66.7 in the treatment group and 50 in the control group. The healing rate of small perforation was 94.4 in the treatment group and 85.0 in the control group at 2 months. There was no significant difference between the treatment group and the control group (P0.05). The average healing time of the two groups was significantly shorter than that of the control group (P0.05). Hearing gain: there was no significant difference in the average hearing threshold between the two groups before treatment (P0.05), but after the healing of tympanic membrane perforation, the difference between the two groups was statistically significant (P0.05), the average hearing threshold of the control group was higher than that of the treatment group. The results suggest that albumin therapy is beneficial to the recovery of hearing symptoms in traumatic tympanic membrane perforation. Conclusion: 1. Albumin could significantly promote the healing of traumatic tympanic membrane perforation, increase the healing rate, shorten the healing time, and the transparency of the tympanic membrane was close to that of the normal tympanic membrane after healing. Albumin can be used as an economical, simple, safe and effective method to treat traumatic tympanic membrane perforation. It can not only reduce the economic burden of patients, but also avoid the large trauma caused by surgery. And the technology can also be popularized in primary hospitals.
【学位授予单位】：延安大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R764.9

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