MEBO棉片贴补治疗外伤性鼓膜大穿孔的临床分析

Moist Exposed Burn Ointment cotton patch in endoscopic treatment of large traumatic tympanic membrane perforation

目的 观察美宝湿润烧伤膏（Moist Exposed Burn Ointment,MEBO）棉片贴补法治疗外伤性鼓膜大穿孔的临床疗效。方法 将2008-01-2015-06期间就诊的113例外伤性鼓膜大穿孔患者经知情同意后按照前瞻、随机的原则分为3组：湿润烧伤膏棉片贴补组（A组,42例）、单纯棉片贴补组（B组,38例）、干燥自愈法组（C组,33例）。A、B组在耳内镜下分别行湿润烧伤膏棉片贴补和单纯棉片贴补治疗,每3-5d取出棉片观察;C组每3-5d观察,分别记录穿孔愈合情况、有无感染及愈合时间。结果 A、B、C组分别愈合39例（92.9%）、17例（44.7%）、10例（30.3%）,平均愈合时间分别为（11.8±2.8）d、（20.5±2.1）d、（28.7±6.2）d。A组愈合率明显高于B、C组,均差异有统计学意义（P〈0.01）;B组愈合率高于C组,差异无统计学意义（P〉0.05）。3组患者的平均愈合时间有显著差异（P〈0.01）。3组中无明显诱因分别出现感染3例（7.1%）、10例（26.3%）、9例（27.3%）,A组感染率明显低于B、C组,差异有统计学意义（P〈0.05）;B组和C组的感染率接近,差异无统计学意义（P〉0.05）。随访期间,未发生严重并发症。结论 湿润烧伤膏棉片贴补治疗外伤性鼓膜大穿孔能够提高穿孔愈合率,缩短愈合时间,降低感染率,无严重并发症,可使多数患者避免了手术治疗,降低了医药费用。

Objective To report treatment outcomes of Moist Exposed Bum Ointment （MEBO） cotton patch for large traumatic tympanic membrane perforation. Methods A total of 113 ears with large traumatic tympanic membrane perfora- tion seen from January 2008 to June 2015 were randomly selected to receive MEBO cotton patch treatment under an endo- scope （group A, n=42）, treatment with cotton patches under an endoscope （group B, n=38） or simply follow up （group C, n= 33）. All the patients were followed up every 3 to 5 days. The rate of closure, time to closure and rate of infection were com- pared between groups. Results The rate of tympanic membrane closure was 92.9% （39/42）, 44.7% （17/38） and 30.3% （10/ 33） in Groups A, B and C, respectively, with the rate in Group A being higher than those in Groups B and C （P 〈 0.01）. The rate of closure in Group B was higher than that in Group C （P 〉 0.05）. The time to tympanic membrane closure in Groups A, B and C was 11.8±2.8 days, 20.5±2.1 days and 28.7±6.2 days, respectively （P 〈 0.01）. The number of infection of unclear causes in Groups A, B and C was 3 （7.1%）, 10 （26.3%） and 9 （27.3%）, respectively, with the rate of infection in Group A be- ing lower than those in Groups B and C （P 〈 0.05） and no significant difference between Groups B and C （P 〉 0.05）. For the follow up period of 6 months to 3 years, there were no complications. Conclusion The Moist Exposed Burn Ointment cot- ton patch can effectively promote closure, shorten time to closure and reduce infection when used in treating large traumatic tympanic membrane perforation, with little or no complications. This approach can help avoid operation and reduce medical expenses in most patients.