鼓膜置管术治疗儿童分泌性中耳炎的疗效及术后复发的影响因素分析

Effect of tympanum catheterization on otitis media with effusion in children and influencing factors of postoperative recurrence

目的探究鼓膜置管术治疗儿童分泌性中耳炎(OME)的疗效并分析患儿术后复发的影响因素。方法选取2017年7月至2019年6月山西省儿童医院收治的130例OME患儿作为研究对象,随机分为两组,对照组(65例)采取保守治疗,观察组(65例)采取鼓膜置管术治疗,比较保守治疗和鼓膜置管术治疗的临床疗效和术后并发症、各频率骨导听阈等情况;对鼓膜置管术治疗患儿随访1年,根据术后是否复发分为复发组(18例)和未复发组(47例),比较复发组和未复发组患儿的一般资料;多因素Logistic回归分析影响OME患儿术后复发的因素;构建预测术后复发的列线图预测模型,并评价其预测效能。结果鼓膜置管术治疗的总有效率明显高于保守治疗,术后并发症发生率明显低于保守治疗,治疗后患儿骨导听阈和临床疗效也明显优于对照组患儿。小龄、通气管保留时间短、反复呼吸道感染、乳突气化不良、过敏性鼻炎均是导致鼓膜置管术治疗OME患儿术后复发的危险因素。构建的列线图预测模型区分度较好,校准度较高。结论鼓膜置管术治疗儿童OME具有总有效率高、术后并发症少、临床疗效好、见效快等优势,构建OME患儿术后复发的风险预测模型为临床上提高患儿生存率提供参考。

Objective To explore the efficacy of tympanic membrane catheterization in the treatment of otitis media with effusion(OME)in children and analyze the influencing factors of postoperative recurrence.Methods A total of 130 children with OME admitted to Children’s Hospital of Shanxi from July 2017 to June 2019 were selected as the study subjects.They were randomly divided into two groups.65 cases in the control group received conservative treatment,65 cases in the observation group received tympanic membrane catheterization treatment.The clinical efficacy,postoperative complications,bone conduction threshold at different frequencies were compared between conservative treatment and tympanic membrane catheterization treatment.The children treated by tympanic membrane catheterization were followed up for 1 year,and were divided into the recurrence group(18 cases)and the non-recurrence group(47 cases)according to the recurrence of the operation.The general data of the recurrence group and the non-recurrence group were compared.Multivariate Logistic regression analysis of the factors affecting postoperative recurrence of OME children.Construct the prediction model of postoperative recurrence and evaluate its prediction efficiency.Results The total effective rate of tympanostomy was significantly higher than that of conservative treatment,and the incidence of postoperative complications was significantly lower than that of conservative treatment,and the threshold of bone conduction and clinical efficacy were also significantly better than that of the control group.Small age,short ventilatory tube retention time,recurrent respiratory tract infection,poor mastoid gasification and allergic rhinitis were all risk factors for postoperative recurrence of OME patients treated by tympanostomy catheterization.The constructed prediction model has a good prediction distinction and a high calibration degree.Conclusion Tympanostomy in the treatment of OME in children has the advantages of high total effective rate,fewer postoperative complications,good clinical efficacy and quick response,etc.The construction of risk prediction model for postoperative recurrence of OME patients can provide reference for improving the survival rate of patients in clinic.