外伤性鼓膜穿孔临床观察对比研究

Comparative study of the clinical observation on traumatic perforation of tympanic membrane

目的:探讨沙棘油贴补治疗不同穿孔大小的外伤性鼓膜穿孔临床疗效。方法:将2012-12-2014-12期间门诊就诊的199例外伤性鼓膜穿孔患者,经知情同意后按照前瞻、随机的原则分为治疗组(101例)和对照组(98例)。每组按照穿孔大小分为小穿孔组、中穿孔组和大穿孔组;治疗组的小、中和大穿孔组分别为36、34和31例,给予沙棘油贴补治疗,1次/周;对照组的小、中和大穿孔组分别为35、33和30例,等待自然愈合,每周复查1次。随访2个月,以愈合率作为2组临床疗效评价指标,比较2组在1个月和2个月的愈合率、平均愈合时间以及愈合鼓膜形态变化。结果:治疗组1个月和2个月时的穿孔总愈合率分别为62.4%和79.2.%,对照组1个月和2个月的穿孔总愈合率分别29.6%和57.1%,均差异有统计学意义(P<0.05)。其中治疗组的中穿孔和大穿孔组的愈合率与对照组相比较,均差异有统计学意义(P<0.05)。而外伤性鼓膜小穿孔的愈合率治疗组与对照组比较,差异无统计学意义(P>0.05)。2个月时外伤性鼓膜穿孔治疗组的大、中、小穿孔平均愈合时间与对照组比较均明显缩短(P<0.05)。结论:外伤性鼓膜小穿孔自愈率较高,可采用观察等待穿孔自愈法,而鼓膜中、大穿孔自愈率低,需采用沙棘油贴补治疗,以提高穿孔愈合率,缩短穿孔愈合时间,尽快恢复中耳功能,可使多数患者避免了手术治疗,减少了医药费用,值得临床推广使用。

Objective： To explore the clinical treatment effects of sea buckthorn oil for in different size trau- matic perforation of tympanic membrane in different size. Method.. Prospective, randomized study of 199 outpa- tients with traumatic perforation of tympanic membrane who were enrolled between December 2012 and December 2014 after informed consent. The patients were divided into treatment group （101 cases） and control group （98 ca- ses）. According to the size of the perforations, patients in each group were divided into large perforation group, middle perforation groups and small perforation group. The cases in large perforation group, middle perforationl groups and small perforation group were 36,34,31 in treatment group and 35,33,30 in control group. The patients in treatment group were treated with sea buckthorn oil once a week, while the patient in control group were self- healing and checked once a week. All the patients were followed-up in two months. The healing rate of two groups was applied for the evaluation indicator of clinical effect. We compared the healing rate, average healing time and phological change of tympanic membrane of patients at the first and second month. Result：The total healing ratio of patients in treatment group is 62.4% and 79.2~ compared with 29.6% and 57.1% in control group at the first and second month （P〈0.05）. There is statistical significance between the healing ratios of middle, large perfora- tion groups in treatment group and control group（P〈0.05）. There is no statistical significance between the heal- ing ratios of small perforation group in treatment group and control group（P〉0.05）. The average healing time of large, middle and small perforation group at the second month are significantly shorter than the control group. Conclusion：It is better to apply observation method and let it self-healed for small traumatic tympanic membrane perforation according to its higher healing ratio. While, it is better to apply sea buckthorn oil method for middle and large traumatic tympanic membrane perforation according to its lower healing ratios. Sea buckthorn oil treat- ment is benefitial for increasing the ratio of perforation healing, shorten the healing time, resumpting of the middle ear function earlier, helping most of the patients to avoid operation and the reduce medical expense. Therefore, it is valuable to promote the method in clinical treatment.