慢性化脓性中耳炎术后复发相关因素分析

目的 分析慢性化脓性中耳炎(CSOM)术后复发的相关因素,探索预防CSOM术后复发的干预措施。方法 回顾性分析2012年1月至2018年12月在贵州医科大学第三附属医院行手术治疗并达到临床治愈标准的CSOM患者1066例,通过电子病历系统查阅患者临床资料及相关实验室检查,随访1年观察是否复发并分为未复发组与复发组,采用卡方检验和多因素Logistic回归进行两组间相关因素比较。结果 CSOM术后复发率为6.38%。多重耐药菌(MDRO)感染(χ ²=16.338,P=0.000)、年龄≥60岁(χ ²=5.182,P=0.023)、发病频次≥3次/年(χ ²=4.388,P=0.036)、活动期发病持续时间>7 d(χ ²=4.729,P=0.030)、反复上呼吸道感染>3 次/年(χ ²=11.913,P=0.001)、伴慢性鼻窦炎(χ ²=11.077,P=0.001)、血糖>6.11 mmol/L(χ ²=15.327,P=0.000)、术后降钙素原(PCT)>0.5 μg/L(χ ²=8.337,P=0.004)是术后复发的危险因素;使用通气管是术后复发的保护因素(χ ²=5.308,P=0.021)。多因素Logistic回归分析结果显示,术前MDRO感染(OR=3.373,95%CI:1.825~6.234,P=0.000)、反复上呼吸道感染>3 次/年(OR=2.727,95%CI:1.479~5.030,P=0.001)、慢性鼻窦炎(OR=2.980,95%CI:1.654~5.369,P=0.000)、血糖(>6.11 mmol/L)(OR=3.219,95%CI:1.741~5.953,P=0.000)、PCT(>0.5 μg/L)(OR=2.085,95%CI:1.106~3.931,P=0.023)是CSOM患者术后复发的独立危险因素。结论 做好MDRO感染防控、控制血糖、预防上呼吸道感染、减少慢性鼻窦炎复发是降低CSOM术后复发的主要措施。监测PCT可为临床早期发现与早期干预提供参考依据。

Risk Factors for Postoperative Recurrence of Chronic Suppurative Otitis Media

Objective To analyze the risk factors for postoperative recurrence of chronic suppurative otitis media(CSOM) and explore the intervention measures to prevent postoperative recurrence of CSOM. Methods A total of 1066 patients with CSOM who underwent concurrent surgical treatment and achieved clinical cure in our hospital from January 2012 to December 2018 were enrolled.The clinical data and laboratory findings were reviewed by using an electronic medical record system and the patients were followed up for 1 year.The patients were divided into the non-recurrent group and the recurrent group.Chi-square test and multivariate logistic regression were used to compare the factors may contribute to the postoperative recurrence. Results The recurrence rate of CSOM was 6.38%.Multi-drug-resistant(MDR) infection before surgery(χ ²=16.338,P=0.000),aged ≥60 years(χ ²=5.182,P=0.023),frequency of occurrence ≥3 times/year(χ ²=4.388,P=0.036),duration of active period>7 d(χ ²=4.729,P=0.030),repeated upper respiratory tract infection>3 times/year(χ ²=11.913,P=0.001),accompanied by chronic sinusitis(χ ²=11.077,P=0.001),blood glucose>6.11 mmol/L(χ ²=15.327,P=0.000),postoperative serum procalcitonin(PCT)>0.5 μg/L(χ ²=8.337,P=0.004) were the risk factors for postoperative recurrence.The use of snorkel was a protective factor for postoperative recurrence(χ ²=5.308,P=0.021).Multivariate analysis showed that MDR infection(OR=3.373,95%CI:1.825-6.234,P=0.000),repeated upper respiratory tract infection>3 times/year(OR=2.727,95%CI:1.479-5.030,P=0.001),accompanied by chronic sinusitis(OR=2.980,95%CI:1.654-5.369,P=0.000),blood glucose>6.11 mmol/L(OR=3.219,95%CI:1.741-5.953,P=0.000),and postoperative serum PCT>0.5 μg/L(OR=2.085,95%CI:1.106-3.931,P=0.023) were independent risk factors for postoperative recurrence in CSOM patients. Conclusions Effective prevention and control of MDR infection,control of blood sugar,prevention of upper respiratory tract infection,and lowering the recurrence of chronic sinusitis are the main measures to reduce postoperative recurrence of CSOM.Monitoring of the infection marker PCT can help to achieve early intervention.