医用透明质酸钠凝胶联合明胶海绵鼓室填塞在中耳炎鼓室成形术中的应用

Application of medical sodium hyaluronate gel combined with gelatin sponge packs in tympanoplasty for otitis media

目的研究医用透明质酸钠凝胶联合明胶海绵鼓室填塞在中耳炎鼓室成形术中的应用效果。方法选取于2018年3月至2020年3月在广宁县人民医院耳鼻咽喉科接受治疗的67例拟行鼓室成形术患者进行研究,按照随机数表法分为观察组(n=33)和对照组(n=34)。对照组患者鼓室成形术中应用常规明胶海绵填塞鼓室腔,观察组患者在鼓室成形术中应用医用透明质酸钠凝胶联合明胶海绵填塞鼓室腔。比较两组患者的手术时间、住院费用、住院时间、抗感染时间,比较两组患者术后2周、1个月、3个月耳内镜下鼓膜穿孔愈合和中耳黏连情况、纯音听阈测定听力变化情况、耳部不适症状情况以及术前、术后3 d、1周、2周、1个月、2个月、3个月血红蛋白和白细胞变化情况。结果观察组患者的手术时间、住院时间分别为(26.97±6.68)min、(8.95±2.30)d,明显短于对照组的(50.89±6.59)min、(11.78±3.18)d,抗感染时间为(7.12±0.89)d,明显长于对照组的(4.27±0.26)d,住院费用为(1.16±0.53)万元,明显少(低)于对照组的(1.79±1.05)万元,差异均有统计学意义(P<0.05);观察组患者术后2周、1个月、3个月的鼓膜穿孔愈合率分别为72.73%、87.88%、96.97%,明显高于对照组的38.24%、50.00%、64.71%;中耳黏连率分别为18.18%、9.09%、3.03%,明显低于对照组的41.18%、29.41%、23.53%,差异均有统计学意义(P<0.05);观察组患者术后2周、1个月、3个月的纯音听阈测定各频率间气导提高水平明显优于对照组,差异均有统计学意义(P<0.05);观察组患者术后2周、1个月、3个月的耳部不适症状发生率分别为63.64%、33.33%、9.09%,明显低于对照组的85.29%、58.82%、32.35%,差异均有统计学意义(P<0.05);术后2周、1个月、3个月,两组患者血红蛋白、白细胞水平均较术前明显改善,观察组患者的血红蛋白水平分别为(100.29±3.15)g/L、(110.24±4.11)g/L、(120.36±4.27)g/L,明显高于对照组的(95.51±3.27)g/L、(100.28±4.09)g/L、(110.32±3.41)g/L,白细胞水平分别为(11.79±3.96)×10^(9)/L、(8.29±3.57)×10^(9)/L、(4.12±2.01)×10^(9)/L,明显低于对照组的(15.83±3.78)×10^(9)/L、(12.91±3.74)×10^(9)/L、(8.42±2.45)×10^(9)/L,差异均具有统计学意义(P<0.05)。结论中耳炎鼓室成形术中应用医用透明质酸钠凝胶联合明胶海绵填塞鼓室腔能有效提高患者术后鼓膜穿孔愈合率,减少并发症和耳部不适症状发生率,改善患者听力和机体感染状况,其临床治疗效果显著。

Objective To study the application effect of medical sodium hyaluronate gel combined with gelatin sponge packs in tympanoplasty for otitis media and provide guidance for clinical treatment.Methods A total of 67 patients who received tympanoplasty in Department of Otolaryngology,Guangning People’s Hospital from March 2018 to March 2020 were selected for research,and they were divided into treatment group(n=33)and control group(n=34)according to the random number table.The conventional gelatin sponge packs were used to fill the tympanic cavity in the control group,and the medical sodium hyaluronate gel combined with gelatin sponge packs were used to fill the tympanic cavity in the treatment group.The operation time,hospitalization costs,length of hospital stay,anti-infection time,the healing of tympanic membrane perforation under otoscope and middle ear adhesions,pure tone hearing threshold hearing changes,ear discomfort symptoms in the two groups 2 weeks,1 month,and 3 months after operation,and changes in hemoglobin and white blood cell values before and after 3 d,1 week,2 weeks,1 month,2 months,and 3 months were compared.Results The operation time and hospital stay in the treatment group were(26.97±6.68)min and(8.95±2.30)days,which were significantly shorter than(50.89±6.59)min and(11.78±3.18)days in the control group.The anti-infection time was(7.12±0.89)d,which was significantly longer than(4.27±0.26)d in the control group.The hospitalization expenses was(1.16±0.53)×10~4 yuan,which was significantly less than(1.79±1.05)×10~4 yuan in the control group(P<0.05).The healing rate of tympanic membrane perforation at 2 weeks,1 month,and 3 months in the treatment group were 72.73%,87.88%,and 96.97%,which were significantly higher than 38.24%,50.00%,and 64.71%in the control group.The adhesion rates of the middle ear were 18.18%,9.09%,and 3.03%,which were significantly less(lower)than41.18%,29.41%,and 23.53%of the control group(P<0.05).The air conductance improvement of the pure tone hearing threshold measured at 2 weeks,1 month,and 3 months after operation in the treatment group was significantly better than that in the control group(P<0.05).The incidence of ear discomfort at 2 weeks,1 month,and 3 months in the treatment group were 63.64%,33.33%,and 9.09%,which were significantly lower than 85.29%,58.82%,and 32.35%in the control group(P<0.05).The hemoglobin and white blood cell levels of the two groups were significantly improved at 2 weeks,1 month,and 3 months after surgery;the hemoglobin levels of the treatment group were(100.29±3.15)g/L,(110.24±4.11)g/L,(120.36±4.27)g/L,which were significantly higher than(95.51±3.27)g/L,(100.28±4.09)g/L,(110.32±3.41)g/L in the control group;the white blood cell levels were(11.79±3.96)×10^(9)/L,(8.29±3.57)×10^(9)/L,(4.12±2.01)×10^(9)/L,which were significantly lower than(15.83±3.78)×10^(9)/L,(12.91±3.74)×10^(9)/L and(8.42±2.45)×10^(9)/L in the control group;the differences were all statistically significant(P<0.05).Conclusion The application of medical sodium hyaluronate gel combined with gelatin sponge packs in tympanoplasty for otitis media has a good clinical treatment effect,which can effectively improve the healing rate of postoperative tympanic membrane perforation,reduce the incidence of complications and ear discomfort symptoms,improve the hearing and the infection status of the body,and improve the hearing and infection status of the patients.