术前耳分泌物病原菌分布特点及其与慢性化脓性中耳炎术后干耳的关系

Distribution characteristics of pathogenic bacteria in preoperative ear secretion and their relationship with postoperative dry ear in chronic suppurative otitis media

目的探讨术前耳分泌物病原菌分布特点及其与慢性化脓性中耳炎(chronic suppurative otitis media,CSOM)术后干耳的关系。方法选取2017年1月~2020年10月南京鼓楼医院集团宿迁医院收治的104例CSOM患者为研究对象,术前检测耳分泌物病原菌并记录其分布特点;均行开放式乳突改良根治术,术后随访6个月;分析影响CSOM术后干耳的因素及耳分泌物病原菌感染对术后干耳的预测价值。结果104例CSOM患者有85例(81.73%)培养出病原菌,共检出94株,其中革兰阳性菌38株(40.43%)、革兰阴性菌18株(19.15%)、真菌38株(40.43%)。Logistic多因素回归分析显示术前耳分泌物病原菌多重感染、咽鼓管功能障碍是影响CSOM术后干耳的独立因素(P<0.05)。术前耳分泌物病原菌多重感染预测CSOM术后不干耳的灵敏度、特异度、曲线下面积(area under the curve,AUC)分别为68.00%、69.62%、0.773(95%CI:0.666~0.880)。结论CSOM术前耳分泌物病原菌感染以革兰阳性菌、真菌感染为主,术前耳分泌物病原菌多重感染、咽鼓管功能障碍与术后不干耳的发生有关,术前耳分泌物病原菌多重感染预测CSOM术后不干耳具有一定效能。

Objective To investigate the distribution characteristics of pathogenic bacteria in preoperative ear secretions and their relationship with postoperative dry ear in chronic suppurative otitis media(CSOM).Methods A total of 104 CSOM patients admitted to our hospital from January 2017 to October 2020 were selected.Preoperative detection of pathogenic bacteria in ear secretions and their characteristics were recorded.All patients received open modified radical mastoidectomy and were followed up for 6 months.The factors affecting postoperative dry ear in CSOM and the predictive value of pathogen in ear secretions on postoperative dry ear were analyzed.Results Pathogenic bacteria were cultured in 85 of 104 CSOM patients(81.73%),with a total of 94 strains detection,including 38 gram-positive(40.43%),18 gram-negative(19.15%),and 38 fungi(40.43%)strains.Logistic multivariate regression analysis showed that multiple infections of preoperative ear secretion pathogens and eustachian tube dysfunction were independent factors of postoperative dry ear in CSOM(P<0.05).The sensitivity,specificity and area under the curve(AUC)of preoperative ear secretion pathogenic bacteria infection in predicting non dry ear in CSOM were 68.00%,69.62%,0.773(95%CI:0.666~0.880),respectively.Conclusion Pathogens of preoperative ear secretions pathogenic bacteria infection in CSOM are mainly gram-positive bacteria and fungi.Preoperative ear secretions pathogenic bacteria infection and eustachian tube dysfunction are related to the occurrence of postoperative non dry ears.Preoperative ear secretion pathogenic bacteria infection is effective in predicting non dry ear after CSOM operation.