鼓膜穿刺加正行吹张治疗儿童分泌性中耳炎疗效分析

发布时间：2019-01-07 10:46

【摘要】：目的:探讨腺样体肥大(adenoidal hypertrophy AH)合并分泌性中耳炎(otitis media with effusion,OME)患儿的治疗上采用腺样体切除术(adenoidectomy AT)+鼓膜穿刺术的基础上加正行吹张与AT+鼓膜穿刺术比较有无优势,为AH合并OME的患儿治疗提供一种新的方法。方法:选择AH合并OME患儿80例,随机分为A、B两组。A组40例(65耳),行AT+鼓膜穿刺术;B组40例(63耳),行AT+鼓膜穿刺术+正行吹张术,术后两组均给予0.5%麻黄碱滴鼻每日三次,共5天,三岁以上患儿给予鼻喷激素(糠酸莫米松)喷鼻每日1次以及分泌物化解药物(欧龙马)3个月。分析两组术后2周、3个月、6个月OME恢复情况,并将A,B两组中耳积液为黏液性的病例(A组25例43耳,B组32例51耳)单独拿出分析二者疗效。采用两独立样本非参数秩和检验对两组的疗效进行评估。结果:A组术后2周治愈率52.31%(34/65),好转率26.15%(17/65),无效率21.54%(14/65),有效率78.46%(51/65);术后3个月治愈率72.31%(47/65),好转率12.31%(8/65),无效率15.38%(10/65),有效率84.62%(55/65);术后6个月治愈率81.54%(53/65),好转率9.23%(6/65),无效率9.23%(6/65),有效率90.77%(59/65)。B组术后2周治愈率66.67%(42/63),好转率14.29%(9/63),无效率19.05%(12/63),有效率80.96%(51/63);术后3个月治愈率82.54%(52/63),好转率7.94%(5/63),无效率9.52%(6/63),有效率90.48%(57/63);术后6个月治愈率92.06%(58/63),好转率3.17%(2/63),无效率4.76%(3/63),有效率95.24%(60/63),有效率=治愈+好转。B组有效率与A组相比无明显统计学意义,P0.05。A组与B组中耳积液为黏液性的患儿术后2周、3个月及6个月治疗效果:A组中耳积液为黏液性患儿术后2周治愈率41.86%(18/43),好转率27.91%(12/43),无效率30.23%(13/43),有效率69.77%(51/43);术后3个月治愈率58.14%(25/43),好转率18.60%(8/43),无效率23.26%(10/43),有效率76.74%(33/43);术后6个月治愈率72.09%(31/43),好转率13.95%(6/43),无效率13.95%(6/43),有效率86.05%(37/43)。B组中耳积液为黏液性患儿术后2周治愈率66.67%(34/51),好转率9.80%(5/51),无效率23.53%(12/51),有效率76.46%(39/51);术后3个月治愈率78.43%(40/51),好转率9.80%(5/51),无效率11.76%(6/51),有效率88.24%(45/51);术后6个月治愈率90.20%(46/51),好转率3.92%(2/51),无效率5.88%(3/51),有效率94.12%(48/51),有效率=治愈+好转。B组有效率与A组相比有统计学意义,P0.05。结论:AT+鼓膜穿刺术+正行吹张术与AT+鼓膜穿刺术在治疗儿童AH合并OME患儿均为比较好的方法,疗效确切。对于中耳积液为浆液性时选择AT+鼓膜穿刺术即可达到满意疗效,而对于中耳积液为黏液性时选择AT+鼓膜穿刺术+正行吹张术治疗效果优于AT+鼓膜穿刺术。
[Abstract]:Objective: to investigate adenoid hypertrophy (adenoidal hypertrophy AH) with secretory otitis media (otitis media with effusion, OME). On the basis of adenoidectomy, (adenoidectomy AT) tympanic membrane puncture combined with positive myringotomy and AT tympanic membrane puncture, we can provide a new method for the treatment of AH combined with OME. Methods: 80 cases of AH combined with OME were randomly divided into two groups: group A (40 cases, 65 ears), AT tympanic membrane puncture; In group B, 40 cases (63 ears) were treated with AT tympanic membrane puncture and were treated with 0.5% ephedrine nasal drops three times a day for 5 days. Children over 3 years of age were given nasal spray of glucocorticoid (momethasone furoate) once a day and exudate solution (Oroma) for 3 months. The recovery of OME at 2 weeks, 3 months and 6 months after operation in the two groups was analyzed. The patients with mucinous middle ear effusion in group A (group A, 25 cases, 43 ears, group B, 32 cases, 51 ears) were treated separately. Two independent sample non-parametric rank sum tests were used to evaluate the efficacy of the two groups. Results: in group A, the cure rate was 52.31% (34 / 65), the improvement rate was 26.15% (17 / 65), the inefficiency rate was 21.54% (14 / 65), the effective rate was 78.46% (51 / 65). 3 months after operation, the cure rate was 72.31% (47 / 65), the improvement rate was 12.31% (8 / 65), the inefficiency rate was 15.38% (10 / 65), and the effective rate was 84.62% (55 / 65). Six months after operation, the cure rate was 81.54% (53 / 65), the improvement rate was 9.23% (6 / 65), the inefficiency rate was 9.23% (6 / 65), the effective rate was 90.77% (59 / 65). B group), the cure rate was 66.67% (42 / 63) two weeks after operation. The improvement rate was 14.29% (9 / 63), the inefficiency was 19.05% (12 / 63), the effective rate was 80.96% (51 / 63). 3 months after operation, the cure rate was 82.54% (52 / 63), the improvement rate was 7.94% (5 / 63), the ineffective rate was 9.52% (6 / 63), the effective rate was 90.48% (57 / 63). Six months after surgery, the cure rate was 92.06% (58 / 63), the improvement rate was 3.17% (2 / 63), the ineffective rate was 4.76% (3 / 63), the effective rate was 95.24% (60 / 63). There was no significant difference in the effective rate between group B and group A. there was no significant difference in the effective rate between group B and group A. the children with middle ear effusion in group B and group A had mucinous effusion 2 weeks after operation. In group A, the cure rate was 41.86% (18 / 43), the improvement rate was 27.91% (12 / 43), the inefficiency rate was 30.23% (13 / 43), the cure rate was 41.86% (18 / 43) 2 weeks after operation. The effective rate was 69.77% (51 / 43); 3 months after operation, the cure rate was 58.14% (25 / 43), the improvement rate was 18.60% (8 / 43), the ineffective rate was 23.26% (10 / 43), the effective rate was 76.74% (33 / 43). Six months after surgery, the cure rate was 72.09% (31 / 43), the improvement rate was 13.95% (6 / 43), the inefficiency rate was 13.95% (6 / 43), The effective rate was 86.05% (37 / 43). B), the cure rate was 66.67% (34 / 51), the improvement rate was 9.80% (5 / 51), the non-effective rate was 23.53% (12 / 51). The effective rate was 76.46% (39 / 51); 3 months after operation, the cure rate was 78.43% (40 / 51), the improvement rate was 9.80% (5 / 51), the ineffective rate was 11.76% (6 / 51), the effective rate was 88.24% (45 / 51). Six months after surgery, the cure rate was 90.20% (46 / 51), the improvement rate was 3.92% (2 / 51), the ineffective rate was 5.88% (3 / 51), the effective rate was 94.12% (48 / 51). The effective rate of group B was significantly higher than that of group A (P 0.05). Conclusion: both AT tympanic membrane puncture and AT tympanic membrane puncture are good methods in the treatment of children with AH and OME. The effect of AT tympanic membrane puncture was satisfactory when middle ear effusion was serous, while AT tympanic membrane puncture was superior to AT tympanic membrane puncture for middle ear effusion with mucus.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R764.21

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