中国医学科学院学报

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中国医学科学院学报

中国医学科学院学报 ›› 2020, Vol. 42 ›› Issue (1): 62-66.doi: 10.3881/j.issn.1000-503X.11203

• 论著 • 上一篇    下一篇

慢性化脓性中耳炎术后复发相关因素分析

谢朝云1(),陈东2,熊芸1,陈应强3,蒙桂鸾1,杨忠玲4   

  1. 1 感染管理科 贵州医科大学第三附属医院, 贵州都匀 558000
    2 耳鼻喉科 贵州医科大学第三附属医院, 贵州都匀 558000
    3 感染科 贵州医科大学第三附属医院, 贵州都匀 558000
    4 检验科 贵州医科大学第三附属医院, 贵州都匀 558000
  • 收稿日期:2019-01-27 出版日期:2020-02-28 发布日期:2020-03-05
  • 通讯作者: 谢朝云 E-mail:xcu2009@163.com
  • 基金资助:
    贵州省科技厅联合项目(黔科合LH字[2014]7162号);贵州省黔南州社会发展科技项目(黔南科合社字[2018]7号)

Risk Factors for Postoperative Recurrence of Chronic Suppurative Otitis Media

XIE Zhaoyun1(),CHEN Dong2,XIONG Yun1,CHEN Yingqiang3,MENG Guiluan1,YANG Zhongling4   

  1. 1 Department of Infections Management, Third Affiliated Hospital of Guizhou Medical University,Duyun,Guizhou 558000,China
    2 Department of Otolaryngology, Third Affiliated Hospital of Guizhou Medical University,Duyun,Guizhou 558000,China
    3 Department of Infectious Diseases, Third Affiliated Hospital of Guizhou Medical University,Duyun,Guizhou 558000,China
    4 Department of Clinical Laboratory,Third Affiliated Hospital of Guizhou Medical University,Duyun,Guizhou 558000,China
  • Received:2019-01-27 Online:2020-02-28 Published:2020-03-05
  • Contact: Zhaoyun XIE E-mail:xcu2009@163.com
  • Supported by:
    Supported by the Guizhou Provincial Science and Technology Department Joint Project(黔科合LH字[2014]7162号);the Guizhou Province Qiannan Prefecture Social Development Science and Technology Project(黔南科合社字[2018]7号)

摘要:

目的 分析慢性化脓性中耳炎(CSOM)术后复发的相关因素,探索预防CSOM术后复发的干预措施。方法 回顾性分析2012年1月至2018年12月在贵州医科大学第三附属医院行手术治疗并达到临床治愈标准的CSOM患者1066例,通过电子病历系统查阅患者临床资料及相关实验室检查,随访1年观察是否复发并分为未复发组与复发组,采用卡方检验和多因素Logistic回归进行两组间相关因素比较。结果 CSOM术后复发率为6.38%。多重耐药菌(MDRO)感染(χ 2=16.338,P=0.000)、年龄≥60岁(χ 2=5.182,P=0.023)、发病频次≥3次/年(χ 2=4.388,P=0.036)、活动期发病持续时间>7 d(χ 2=4.729,P=0.030)、反复上呼吸道感染>3 次/年(χ 2=11.913,P=0.001)、伴慢性鼻窦炎(χ 2=11.077,P=0.001)、血糖>6.11 mmol/L(χ 2=15.327,P=0.000)、术后降钙素原(PCT)>0.5 μg/L(χ 2=8.337,P=0.004)是术后复发的危险因素;使用通气管是术后复发的保护因素(χ 2=5.308,P=0.021)。多因素Logistic回归分析结果显示,术前MDRO感染(OR=3.373,95%CI:1.825~6.234,P=0.000)、反复上呼吸道感染>3 次/年(OR=2.727,95%CI:1.479~5.030,P=0.001)、慢性鼻窦炎(OR=2.980,95%CI:1.654~5.369,P=0.000)、血糖(>6.11 mmol/L)(OR=3.219,95%CI:1.741~5.953,P=0.000)、PCT(>0.5 μg/L)(OR=2.085,95%CI:1.106~3.931,P=0.023)是CSOM患者术后复发的独立危险因素。结论 做好MDRO感染防控、控制血糖、预防上呼吸道感染、减少慢性鼻窦炎复发是降低CSOM术后复发的主要措施。监测PCT可为临床早期发现与早期干预提供参考依据。

关键词: 慢性化脓性中耳炎, 手术, 复发, 相关因素分析

Abstract:

Objective To analyze the risk factors for postoperative recurrence of chronic suppurative otitis media(CSOM) and explore the intervention measures to prevent postoperative recurrence of CSOM. Methods A total of 1066 patients with CSOM who underwent concurrent surgical treatment and achieved clinical cure in our hospital from January 2012 to December 2018 were enrolled.The clinical data and laboratory findings were reviewed by using an electronic medical record system and the patients were followed up for 1 year.The patients were divided into the non-recurrent group and the recurrent group.Chi-square test and multivariate logistic regression were used to compare the factors may contribute to the postoperative recurrence. Results The recurrence rate of CSOM was 6.38%.Multi-drug-resistant(MDR) infection before surgery(χ 2=16.338,P=0.000),aged ≥60 years(χ 2=5.182,P=0.023),frequency of occurrence ≥3 times/year(χ 2=4.388,P=0.036),duration of active period>7 d(χ 2=4.729,P=0.030),repeated upper respiratory tract infection>3 times/year(χ 2=11.913,P=0.001),accompanied by chronic sinusitis(χ 2=11.077,P=0.001),blood glucose>6.11 mmol/L(χ 2=15.327,P=0.000),postoperative serum procalcitonin(PCT)>0.5 μg/L(χ 2=8.337,P=0.004) were the risk factors for postoperative recurrence.The use of snorkel was a protective factor for postoperative recurrence(χ 2=5.308,P=0.021).Multivariate analysis showed that MDR infection(OR=3.373,95%CI:1.825-6.234,P=0.000),repeated upper respiratory tract infection>3 times/year(OR=2.727,95%CI:1.479-5.030,P=0.001),accompanied by chronic sinusitis(OR=2.980,95%CI:1.654-5.369,P=0.000),blood glucose>6.11 mmol/L(OR=3.219,95%CI:1.741-5.953,P=0.000),and postoperative serum PCT>0.5 μg/L(OR=2.085,95%CI:1.106-3.931,P=0.023) were independent risk factors for postoperative recurrence in CSOM patients. Conclusions Effective prevention and control of MDR infection,control of blood sugar,prevention of upper respiratory tract infection,and lowering the recurrence of chronic sinusitis are the main measures to reduce postoperative recurrence of CSOM.Monitoring of the infection marker PCT can help to achieve early intervention.

Key words: chronic suppurative otitis media, surgery, recurrence, risk factor

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