鼓膜穿刺加正行吹張治療兒童分泌性中耳炎療效分析
發(fā)布時間：2019-01-07 10:46
【摘要】：目的:探討腺樣體肥大(adenoidal hypertrophy AH)合并分泌性中耳炎(otitis media with effusion,OME)患兒的治療上采用腺樣體切除術(shù)(adenoidectomy AT)+鼓膜穿刺術(shù)的基礎(chǔ)上加正行吹張與AT+鼓膜穿刺術(shù)比較有無優(yōu)勢,為AH合并OME的患兒治療提供一種新的方法。方法:選擇AH合并OME患兒80例,隨機(jī)分為A、B兩組。A組40例(65耳),行AT+鼓膜穿刺術(shù);B組40例(63耳),行AT+鼓膜穿刺術(shù)+正行吹張術(shù),術(shù)后兩組均給予0.5%麻黃堿滴鼻每日三次,共5天,三歲以上患兒給予鼻噴激素(糠酸莫米松)噴鼻每日1次以及分泌物化解藥物(歐龍馬)3個月。分析兩組術(shù)后2周、3個月、6個月OME恢復(fù)情況,并將A,B兩組中耳積液為黏液性的病例(A組25例43耳,B組32例51耳)單獨拿出分析二者療效。采用兩獨立樣本非參數(shù)秩和檢驗對兩組的療效進(jìn)行評估。結(jié)果:A組術(shù)后2周治愈率52.31%(34/65),好轉(zhuǎn)率26.15%(17/65),無效率21.54%(14/65),有效率78.46%(51/65);術(shù)后3個月治愈率72.31%(47/65),好轉(zhuǎn)率12.31%(8/65),無效率15.38%(10/65),有效率84.62%(55/65);術(shù)后6個月治愈率81.54%(53/65),好轉(zhuǎn)率9.23%(6/65),無效率9.23%(6/65),有效率90.77%(59/65)。B組術(shù)后2周治愈率66.67%(42/63),好轉(zhuǎn)率14.29%(9/63),無效率19.05%(12/63),有效率80.96%(51/63);術(shù)后3個月治愈率82.54%(52/63),好轉(zhuǎn)率7.94%(5/63),無效率9.52%(6/63),有效率90.48%(57/63);術(shù)后6個月治愈率92.06%(58/63),好轉(zhuǎn)率3.17%(2/63),無效率4.76%(3/63),有效率95.24%(60/63),有效率=治愈+好轉(zhuǎn)。B組有效率與A組相比無明顯統(tǒng)計學(xué)意義,P0.05。A組與B組中耳積液為黏液性的患兒術(shù)后2周、3個月及6個月治療效果:A組中耳積液為黏液性患兒術(shù)后2周治愈率41.86%(18/43),好轉(zhuǎn)率27.91%(12/43),無效率30.23%(13/43),有效率69.77%(51/43);術(shù)后3個月治愈率58.14%(25/43),好轉(zhuǎn)率18.60%(8/43),無效率23.26%(10/43),有效率76.74%(33/43);術(shù)后6個月治愈率72.09%(31/43),好轉(zhuǎn)率13.95%(6/43),無效率13.95%(6/43),有效率86.05%(37/43)。B組中耳積液為黏液性患兒術(shù)后2周治愈率66.67%(34/51),好轉(zhuǎn)率9.80%(5/51),無效率23.53%(12/51),有效率76.46%(39/51);術(shù)后3個月治愈率78.43%(40/51),好轉(zhuǎn)率9.80%(5/51),無效率11.76%(6/51),有效率88.24%(45/51);術(shù)后6個月治愈率90.20%(46/51),好轉(zhuǎn)率3.92%(2/51),無效率5.88%(3/51),有效率94.12%(48/51),有效率=治愈+好轉(zhuǎn)。B組有效率與A組相比有統(tǒng)計學(xué)意義,P0.05。結(jié)論:AT+鼓膜穿刺術(shù)+正行吹張術(shù)與AT+鼓膜穿刺術(shù)在治療兒童AH合并OME患兒均為比較好的方法,療效確切。對于中耳積液為漿液性時選擇AT+鼓膜穿刺術(shù)即可達(dá)到滿意療效,而對于中耳積液為黏液性時選擇AT+鼓膜穿刺術(shù)+正行吹張術(shù)治療效果優(yōu)于AT+鼓膜穿刺術(shù)。
[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.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R764.21
本文編號：2403568
[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.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R764.21
【參考文獻(xiàn)】
相關(guān)期刊論文 前10條
1 付高尚;徐艷霞;韓富根;;64排CT在兒童分泌性中耳炎診療中的作用[J];中國衛(wèi)生標(biāo)準(zhǔn)管理;2015年28期
2 吳國謙;管志偉;黎潤球;葉貝華;;顯微鏡下鼓膜置管術(shù)與鼓膜穿刺抽吸沖洗法治療小兒分泌性中耳炎的療效比較[J];現(xiàn)代診斷與治療;2015年06期
3 呂建;;對比不同方法治療兒童不同程度分泌性中耳炎的臨床可行性[J];中外醫(yī)療;2015年07期
4 呂蘭;徐家兔;商黎明;俞萍;劉平;楊菲;王煒;陸銀萍;戴國平;;鼓膜置管對腺樣體切除治療兒童分泌性中耳炎療效的影響[J];中國眼耳鼻喉科雜志;2015年01期
5 鄭燕青;陳小蘭;康碧珠;黃麗瑩;詹燕珠;洪銘沿;;鼓膜置管和鼓膜穿刺治療兒童分泌性中耳炎的療效比較[J];福建醫(yī)藥雜志;2014年03期
6 高永平;田從哲;劉會清;孟勝環(huán);劉海燕;;小兒腺樣體肥大與分泌性中耳炎[J];中華耳科學(xué)雜志;2014年01期
7 馮曉華;龍孝斌;汪建;陳勇挺;付曉燕;陳國強(qiáng);;鼓膜置管治療難治性分泌性中耳炎鼓膜穿孔危險因素分析[J];聽力學(xué)及言語疾病雜志;2014年01期
8 陳觀貴;翟錦明;;兒童分泌性中耳炎手術(shù)治療的遠(yuǎn)期轉(zhuǎn)歸[J];中國實用醫(yī)藥;2012年20期
9 陳芳;李曉艷;;鼓膜穿刺和置管治療兒童OSAHS合并分泌性中耳炎療效分析[J];聽力學(xué)及言語疾病雜志;2012年02期
10 郭志俊;田小娟;;鼻內(nèi)鏡下應(yīng)用低溫等離子手術(shù)系統(tǒng)施行腺樣體切除術(shù)治療兒童分泌性中耳炎的臨床研究[J];中國藥物與臨床;2012年02期
，本文編號：2403568
本文鏈接：http://sikaile.net/yixuelunwen/wuguanyixuelunwen/2403568.html
最近更新
教材專著
