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 ›› 2021, Vol. 43 ›› Issue (4): 531-535.doi: 10.3881/j.issn.1000-503X.13273

• 论著 • 上一篇    下一篇

儿童急性化脓性中耳炎鼓膜穿孔相关因素分析

谢朝云1(),陈东2,刘福翔2   

  1. 贵州医科大学第三附属医院 1感染管理科,贵州都匀 558000
    2耳鼻喉科,贵州都匀 558000
  • 收稿日期:2020-08-14 出版日期:2021-08-30 发布日期:2021-09-03
  • 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)

Factors Related to Tympanic Membrane Perforation in Children with Acute Suppurative Otitis Media

XIE Chaoyun1(),CHEN Dong2,LIU Fuxiang2   

  1. 1Department of Infection Management,Guizhou 558000,China
    2Department of Otolaryngology,The Third Affiliated Hospital of Guizhou Medical University,Duyun,Guizhou 558000,China
  • Received:2020-08-14 Published:2021-08-30 Online:2021-09-03
  • Contact: XIE Chaoyun E-mail:xcu2009@163.com
  • Supported by:
    Joint Project of Science and Technology Department of Guizhou Province(黔科合LH字[2014]7162号);Science and Technology Project of Social Development of Qiannan Prefecture of Guizhou Province(黔南科合社字[2018]7号)

摘要:

目的 探讨急性化脓性中耳炎患儿鼓膜穿孔相关因素,为临床提供参考。方法 回顾2017年2月至2020年5月1274例急性化脓性中耳炎患儿临床资料,对其鼓膜穿孔相关因素进行分析。结果 1274例急性化脓性中耳炎患儿鼓膜穿孔67例,鼓膜穿孔发生率为5.27%;单因素分析显示,发病持续时间(t=2.381,P=0.017)、患儿合并上呼吸道感染(χ2=12.228,P=0.000)、肺部感染(χ2=5.242,P=0.022)、慢性鼻窦炎(χ2=12.715,P=0.000)、腺样体肥大(χ2=4.783,P=0.029)、鼓室积脓(χ2=16.020,P=0.000)、使用抗菌药物时间(t=-2.277,P=0.025)、联合使用抗菌药物(χ2=5.587,P=0.018)、发病至根据药敏选用抗菌药物时间(t=3.716,P=0.000)、血清降钙素原(t=2.599,P=0.009)、外周血白细胞计数(t=2.196,P=0.031)等11个因素是急性化脓性中耳炎患儿鼓膜穿孔的相关因素;多因素Logistic分析显示,发病持续时间(OR=4.854,95%CI=2.675~8.806,P=0.000)、患儿合并上呼吸道感染(OR=6.506,95%CI=3.213~13.171,P=0.000)、慢性鼻窦炎(OR=7.866,95%CI=3.780~16.370,P=0.000)、鼓室积脓(OR=2.625,95%CI=1.442~4.777,P=0.002)、发病至根据药敏选用抗菌药物时间(OR=5.107,95%CI=2.129~12.248,P=0.000)等5个因素是急性化脓性中耳炎患儿鼓膜穿孔的独立危险因素。结论 早期治疗、保持咽鼓管通畅、引流鼓室积脓、预防慢性鼻窦炎与上呼吸道感染发生、早期做细菌培养药敏试验并根据药敏结果选用抗菌药物等为主的综合措施,可减少急性化脓性中耳炎患儿鼓膜穿孔发生率。

关键词: 儿童, 急性化脓性中耳炎, 鼓膜穿孔, 相关因素

Abstract:

Objective To explore the factors related to tympanic membrane perforation in children with acute suppurative otitis media,and to provide reference for clinical practice. Methods We reviewed the clinical data of 1274 children with acute suppurative otitis media from February 2017 to May 2020,and analyzed the factors related to tympanic membrane perforation. Results Tympanic membrane perforation occurred in 67 out of the 1274 children with acute suppurative otitis media,with the incidence of 5.27%.The univariate analysis showed that 11 factors including the duration of onset(t=2.381,P=0.017),upper respiratory tract infection(χ2=12.228,P=0.000),pulmonary infection(χ2=5.242, P=0.022),chronic sinusitis(χ2=12.715,P=0.000),adenoid hypertrophy(χ2=4.783,P=0.029),tympanic empyema(χ2=16.020,P=0.000),the duration of using antibiotics(t=-2.277,P=0.025),combined use of antibiotics(χ2=5.587,P=0.018),the time from onset to selection of antibiotics according to drug sensitivity(t=3.716,P=0.000),procalcitonin(t=2.599,P=0.009),and white blood cell count in peripheral blood(t=2.196,P=0.031)were related to tympanic membrane perforation in children with acute suppurative otitis media.The multivariate logistic analysis showed that the duration of onset(OR=4.854,95% CI=2.675-8.806,P=0.000),upper respiratory tract infection(OR=6.506,95% CI=3.213-13.171,P=0.000),chronic sinusitis(OR=7.866,95% CI=3.780-16.370,P=0.000),tympanic empyema(OR=2.625,95% CI=1.442-4.777,P=0.002),and time from onset to selection of antibiotics according to drug sensitivity(OR=5.107,95% CI=2.129-12.248,P=0.000)were independent risk factors for tympanic membrane perforation in children with acute suppurative otitis media. Conclusion The incidence of tympanic membrane perforation in children with acute suppurative otitis media can be reduced by early treatment,keeping the Eustachian tube unobstructed,draining the tympanic cavity,preventing chronic sinusitis and upper respiratory tract infection,early drug sensitivity test,and selection of antibiotics based on the test results.

Key words: children, acute suppurative otitis media, tympanic membrane perforation, related factors

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