地塞米松不同给药方案治疗慢性分泌性中耳炎的临床效果比较

Clinical comparative study of different kind of hormone delivery regimen in the treatment of patients with chronic secretory otitis media

目的 比较地塞米松经鼓膜穿刺和经咽鼓管给药方案治疗慢性分泌性中耳炎临床疗效及安全性.方法 选取浙江省舟山医院2015年1月至2016年9月收治的慢性分泌性中耳炎患者90例,采用随机数字表法分为鼓膜穿刺组（45例）和经咽鼓管组（45例）,分别采用地塞米松经鼓膜穿刺和经咽鼓管给药方案治疗.比较两组的治疗总有效率,治疗前后1 kHz、2 kHz、4 kHz及8 kHz骨导阈值,ETDQ-7评分,实验室指标水平,继发鼓室积液率及随访复发率.结果 鼓膜穿刺组和经咽鼓管组患者治疗总有效率分别为77.78％、93.33％,经咽鼓管组治疗总有效率显著高于鼓膜穿刺组（x2=9.84,P＜0.05）;鼓膜穿刺组治疗后1 kHz、2 kHz、4 kHz及8 kHz骨导阈值分别为（10.42±1.60） kHz,（12.86±2.50） kHz,（16.09 ±2.81） kHz,（15.26±2.68） kHz;经咽鼓管组治疗后1 kHz、2 kHz、4 kHz及8 kHz骨导阈值分别为（9.75±1.36） kHz,（11.13±2.02） kHz,（14.82±2.44） kHz,（13.78 ±±2.11） kHz,经咽鼓管组骨导阈值水平均显著低于鼓膜穿刺组、治疗前（t=3.10、3.56、3.29、3.96、2.87、3.15、2.91、3.28、2.67、2.81、2.78、2.50,均P＜0.05）;经咽鼓管组治疗后ETDQ-7评分均显著低于鼓膜穿刺组、治疗前（t=3.31、3.87、2.89,均P＜0.05）;经咽鼓管组治疗后实验室指标水平均显著优于鼓膜穿刺组、治疗前（t =3.36、3.77、3.71、4.02、2.83、3.06、均P＜0.05）;经咽鼓管组继发鼓室积液率和随访复发率均显著低于鼓膜穿刺组（x2=9.87、12.33、10.67,均P＜0.05）.结论 地塞米松经咽鼓管给药方案治疗慢性分泌性中耳炎在缓解临床症状、改善骨导阈值和咽鼓管功能、调节实验室指标及降低复发和鼓室积液出现方面较鼓膜穿刺方案具有优势.

Objective To investigate the clinical effects and safety differences of endoscopic hormone injection by tympanic membrane puncture and eustachian tube in the treatment of patients with chronic secretory otitis media.Methods From January 2015 to September 2016,90 patients with chronic secretory otitis media in Zhoushan Hospital were chosen.They were randomly divided into two groups according to the digital table.The tympanic membrane puncture group （65 patients） was treated with hormone injection by tympanic membrane puncture and the eustachian tube group（65 patients） was treated with endoscopic hormone injection by eustachian tubeThe total clinical effective rate,the bone conduction threshold value in 1 kHz,2kHz,4kHz and 8kHz,the ETDQ-7 score and the levels of laboratory index before and after treatment,the secondary tympanic effusion rate and the recurrence rate with follow-up of both groups were compared.Results The total clinical effective rate of the tympanic membrane puncture group and eustachian tube group were 77.78% and 93.33%,respectively.The total clinical effective rate of the eustachian tube group were significant higher than that of the tympanic membrane puncture group （x2 =9.84,P 〈 0.05）.The bone conduction threshold value in l kHz,2kHz,4kHz and 8kHz of the tympanic membrane puncture group after treatment were （10.42 ± 1.60） kHz,（12.86 ± 2.50） kHz,（16.09 ± 2.81） kHz,（15.26 ± 2.68） kHz,respectively.The bone conduction threshold value in 1kHz,2kHz,4kHz and 8kHz of the eustachian tube group after treatment were （9.75 ± 1.36） kHz,（11.13 ± 2.02） kHz,（14.82 ± 2.44） kHz,（13.78 ± 2.11） kHz,respectively.The bone conduction threshold value in 1kHz,2kHz,4kHz and 8kHz of the eustachian tube group after treatment were significant lower than those of the tympanic membrane puncture group and those before treatment（t =3.10,3.56,3.29,3.96,2.87,3.15,2.91,3.28,2.67,2.81,2.78,2.50,all P 〈 0.05）.The ETDQ-7 scores of the eustachian tube group after treatment were significant lower than those of the tympanic membrane puncture group and those before treatment（t =3.31,3.87,2.89,all P 〈 0.05）.The levels of laboratory index of the eustachian tube group after treatment were significant higher than those of the tympanic membrane puncture group and those before treatment （t =3.36,3.77,3.71,4.02,2.83,3.06,all P 〈 0.05）.The secondary tympanic effusion rate and the recurrence rate with follow-up of the eustachian tube group were significant lower than those of the tympanic membrane puncture group（x2 =9.87,12.33,10.67,all P 〈 0.05）.Conclusion Compared with endoscopic hormone injection by tympanic membrane puncture,endoscopic hormone injection by eustachian tube in the treatment of patients with chronic secretory otitis media possess the advantages including relieve the clinical symptoms,improve the bone conduction threshold and eustachian tube function,regulate the laboratory indexes and reduce the risk of recurrence and effusion.