中耳气压伤在高压氧治疗中的发生状况及其相关因素研究

Study on the Occurrence of Middle Ear Pneumatic Pressure Injury in Hyperbaric Oxygen Therapy and its Related Factors

目的:探讨高压氧治疗(hyperbaric oxygen therapy,HBOT)并发中耳气压伤的发生率、发生时段、鼓膜损伤程度及发生中耳气压伤的危险因素。方法:以进行HBOT的648例患者为研究对象,计算中耳气压伤的发生率,观察其发生时的舱内压力及鼓膜损伤程度,分析发生中耳气压伤的危险因素。结果:中耳气压伤的发生率为7.4%,主要发生在加压至1.4ATA之前(79.2%),以Teed I级鼓膜损伤为主(64.6%)。鼻咽部炎症、卧位治疗、首次治疗及留置鼻胃管为中耳气压伤的高危因素。鼻咽部炎症、卧位治疗及留置鼻胃管为中耳气压伤的独立危险因素(OR=15.103、2.715、6.601,P<0.05)。结论:HBOT过程中,中耳气压伤的发生率较高,多发生于升压阶段1.4ATA之前,鼻咽部炎症、卧位治疗、首次治疗及留置鼻胃管患者易发生中耳气压伤,应注意识别并采取相应的预防措施。

Objective:To investigate the incidence and duration of hyperbaric oxygen therapy(HBOT),the degree of tympanic membrane damage,and the risk factors for the occurrence of middle ear air pressure injury.Methods:The 648 patients who underwent HBOT were used as the study subjects.The incidence of middle ear pneumatic injury was calculated,the cabin pressure and the degree of tympanic membrane damage at the time of its occurrence were observed,and the risk factors for the occurrence of middle ear pneumatic injury were analyzed.Results:The incidence of middle ear pneumatic injuries was 7.4%,occurring mainly before pressurization to 1.4 ATA(79.2%),with a predominance of Teed-I level tympanic membrane injuries(64.6%).Nasopharyngeal inflammation,prone treatment,first treatment and indwelling nasogastric tube were high risk factors for middle ear pneumatic pressure injury(P<0.05).Nasopharyngeal inflammation,prone treatment and indwelling nasogastric tube were independent risk factors for middle ear pneumatic pressure injury(OR=15.103,2.715,6.601,P<0.05).Conclusion:During HBOT,there is a high incidence of middle ear air pressure injury,which mostly occurs before the 1.4 ATA of the boost phase.Patients with nasopharyngeal inflammation,prone treatment,first treatment and indwelling nasogastric tube are prone to middle ear air pressure injury,which should be identified and preventive measures should be taken accordingly.