头孢他啶预防胆脂瘤型中耳炎术后复发的作用分析

The analysis of the role of Ceftazidime in preventing recurrence of otitis media with cholesteatoma

目的探索头孢他啶预防胆脂瘤型中耳炎患者术后复发的作用。方法选取胆脂瘤型中耳炎患者共81例,随机分为观察组(n=41)与对照组(n=40),在内窥镜下结合鼓膜穿孔和后鼓室对病变采取完全清理,存留外耳道后壁,施行"完壁式"中耳乳突根治术或内置法鼓膜修补术。术后用明胶海绵及碘纺纱条填塞中耳乳突术腔,缝合切口。对照组与观察组患者术后外耳道填塞明胶海绵与纱条14 d,对照组患者术后给予常规抗生素治疗,观察组患者局部滴注头孢他啶治疗,每日2次,2.0 g/次,持续治疗7 d。结果观察组患者治疗有效率为97.56%,对照组患者治疗有效率为90%,两组患者治疗有效率相比差异无统计学意义(χ2=1.998,P<0.05)。术后随访1年,观察组患者外耳道形态好,平滑、完整、干燥,大小接近正常,无外耳道狭窄。随访期内有1例患者出现胆脂瘤复发,但无面瘫和眩晕发生;对照组患者有7例出现复发,其中3例鼓膜再穿孔,4例鼓膜疤痕内陷,两组患者复发率比较,差异具有统计学意义(χ2=24.95,P<0.05)。结论头孢他啶用于临床胆脂瘤型中耳炎术后抗生素的治疗,不仅可以减轻广谱抗生素不合理使用造成的细菌耐药,还可以保证胆脂瘤型中耳炎手术治疗的效果,预防胆脂瘤型中耳炎术后复发。

Objective To explore the role of Ceftazidime in preventing recurrence of otitis media with cholesteatoma. Methods 81 patients with otitis media were randomly divided into observe group（n = 41）and control group（n = 40）, combined with tympanic membrane perforation in the tympanic endoscopic lesions completely cleared and after taking , retention of external auditory canal wall, implementation of＂complete wall＂radical mastoidectomy middle ear or internal law myringoplasty . Postoperative with gelatin sponge and iodoform gauze filling in Middle ear and mastoid cavity, the incision was sutured, and which should be kept for 14 days. The patients in control group were treated with conventional antibiotics , while the patients in observe group ceftazidime were treated with ceftazidime for 7 days. Results The two groups were given the appropriate treatment , effective rate of observe group was 97.56%,and the control group was 90%. It was no significantly different（χ2=1.998,P〈0.05）. Followed up for 1 year , observe group patients’external auditory canal shape is good, smooth , full , dry, near normal size , no external auditory canal stenosis. The recurrence rate of observe group is 2.44%（1/41）,which is lower than that in control group（17.5%）.The difference was statistically significant（χ2 =24.95, P 〈0.001）. Conclusion Ceftazidime can be used for clinical treatment of cholesteatoma surgery antibiotics. Not only can Ceftazidime reduce irrational use of broad-spectrum antibiotic resistant bacteria cause, but also can ensure the effect of surgical treatment of otitis media. It needs more samples to confirm the efficacy.