标题：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

      作者：卢燕梅，陈霄娴    广宁县人民医院耳鼻咽喉科，广东 肇庆 526300

      卷次： 2021年32卷5期

      【摘要】 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)×109/L、(8.29±3.57)×109/L、(4.12±2.01)×109/L，明显低于对照组的(15.83±3.78)×109/L、(12.91±3.74)×109/L、(8.42±2.45)×109/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。
      【关键词】 中耳炎；鼓膜穿孔；鼓室成形术；透明质酸钠；明胶海绵；听力；疗效；并发症
      【中图分类号】 R764.21 【文献标识码】 A 【文章编号】 1003—6350（2021）05—0617—04

Application of medical sodium hyaluronate gel combined with gelatin sponge packs in tympanoplasty for otitismedia.
LU Yan-mei, CHEN Xiao-xian. Department of Otolaryngology, Guangning People's Hospital, Zhaoqing 526300,Guangdong, CHINA
【Abstract】 Objective To study the application effect of medical sodium hyaluronate gel combined with gelatinsponge packs in tympanoplasty for otitis media and provide guidance for clinical treatment. Methods A total of 67 pa-tients who received tympanoplasty in Department of Otolaryngology, Guangning People's Hospital from March 2018 toMarch 2020 were selected for research, and they were divided into treatment group (n=33) and control group (n=34) ac-cording to the random number table. The conventional gelatin sponge packs were used to fill the tympanic cavity in thecontrol group, and the medical sodium hyaluronate gel combined with gelatin sponge packs were used to fill the tympan-ic cavity in the treatment group. The operation time, hospitalization costs, length of hospital stay, anti-infection time, thehealing of tympanic membrane perforation under otoscope and middle ear adhesions, pure tone hearing threshold hear-ing changes, ear discomfort symptoms in the two groups 2 weeks, 1 month, and 3 months after operation, and changes inhemoglobin and white blood cell values before and after 3 d, 1 week, 2 weeks, 1 month, 2 months, and 3 months werecompared. 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 an-ti-infection time was (7.12±0.89) d, which was significantly longer than (4.27±0.26) d in the control group. The hospital-ization expenses was (1.16±0.53)×104 yuan, which was significantly less than (1.79±1.05)×104 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 groupwere 72.73%, 87.88%, and 96.97%, which were significantly higher than 38.24%, 50.00%, and 64.71% in the control