發(fā)布時(shí)間：2018-11-11 09:33

【摘要】：目的:通過局部外用白蛋白治療外傷性鼓膜穿孔,觀察其臨床療效,探尋一種簡(jiǎn)單、安全、有效、便捷的治療外傷性鼓膜穿孔的方法,并使之得到臨床推廣應(yīng)用。方法:選取2015年10月至2017年1月在延安大學(xué)附屬醫(yī)院耳鼻喉科門診或住院確診為外傷性鼓膜穿孔患者80例,男31例,女49例;年齡6~60歲,中位年齡32(11)歲,左耳54例,右耳26例。將外傷性鼓膜穿孔的就診患者按就診奇、偶順序隨機(jī)分為處理組(n=40)和對(duì)照組(n=40),根據(jù)鼓膜穿孔的大小又將處理組和對(duì)照組分別分為最大直徑3mm的小穿孔組、最大直徑3~5mm的中穿孔組、最大直徑5mm的大穿孔組三個(gè)小組[1],處理組給予直接局部外用白蛋白治療,隔天上1次藥,記錄耳內(nèi)鏡資料并保存;對(duì)照組采用傳統(tǒng)干燥法,每3天來院隨訪1次;兩組均口服消炎藥,連服3天,保持咽鼓管通暢,患耳勿入水、保持干燥,避免用力擤鼻,以防感染,并預(yù)防感冒。入組患者均隨訪觀察2月,觀察并記錄鼓膜愈合情況,愈合時(shí)間、聽力增益以及有無感染等并發(fā)癥發(fā)生。療效評(píng)定標(biāo)準(zhǔn)[2]:愈合:鼓膜穿孔完全愈合,愈合鼓膜色澤、形態(tài)與正常鼓膜接近,聽力恢復(fù)正常;好轉(zhuǎn):鼓膜穿孔縮小,愈合不完全,聽力部分改善;無效:穿孔未見明顯變化,聽力改善不明顯。結(jié)果:1.白蛋白治療外傷性鼓膜穿孔,穿孔愈合鼓膜與正常鼓膜極為相似,透明度可,無疤痕。2.兩組1個(gè)月與2個(gè)月的穿孔總愈合率:外傷性鼓膜穿孔1個(gè)月時(shí),處理組總愈合率為57.5%(23/40),對(duì)照組總愈合率為30%(12/40),差異有統(tǒng)計(jì)學(xué)意義(P0.05);2個(gè)月時(shí)處理組總愈合率為85.0%(34/40),對(duì)照組總愈合率為55.0%(22/40),差異有顯著的統(tǒng)計(jì)學(xué)意義(P0.01)。據(jù)穿孔大小:處理組中穿孔與大穿孔1個(gè)月時(shí)愈合率分別為66.7%和30.0%,對(duì)照組分別為16.7%和0,經(jīng)統(tǒng)計(jì)學(xué)檢驗(yàn)差異有統(tǒng)計(jì)學(xué)意義(P0.05);中、大穿孔2個(gè)月時(shí)處理組愈合率為83.3%和70.0%,對(duì)照組為33.3%和12.5%,經(jīng)統(tǒng)計(jì)學(xué)檢驗(yàn)差異均有統(tǒng)計(jì)學(xué)意義(P0.05);處理組1個(gè)月時(shí)小穿孔愈合率為66.7%,對(duì)照組小穿孔為50%;處理組2個(gè)月時(shí)小穿孔愈合率為94.4%,同期對(duì)照組為85.0%,經(jīng)統(tǒng)計(jì)學(xué)檢驗(yàn)差異均無統(tǒng)計(jì)學(xué)意義(P0.05)。3.兩組平均愈合時(shí)間差異:小、中、大穿孔組處理組平均愈合時(shí)間均明顯較對(duì)照組縮短,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。4.聽力增益情況:兩組患者治療前平均聽閾無統(tǒng)計(jì)學(xué)差異(P0.05),但鼓膜穿孔愈合后,兩組平均聽閾差異有統(tǒng)計(jì)學(xué)意義(P0.05),對(duì)照組平均聽閾較處理組高,提示:白蛋白治療有益于外傷性鼓膜穿孔聽力癥狀的恢復(fù)。結(jié)論:1.白蛋白能顯著促進(jìn)外傷性鼓膜穿孔的愈合,提高愈合率,明顯縮短愈合時(shí)間,且愈合后鼓膜透明度接近正常鼓膜,治療后與受傷前聽力基本一致。2.白蛋白可作為治療外傷性鼓膜穿孔經(jīng)濟(jì)、簡(jiǎn)便、安全、療效確切的方法在臨床上推廣,不但可以減輕患者經(jīng)濟(jì)負(fù)擔(dān),也可避免了行手術(shù)給患者帶來較大的創(chuàng)傷,并且該技術(shù)還可在基層醫(yī)院推廣普及。
[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.
【學(xué)位授予單位】：延安大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R764.9

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