哈尔滨市呼兰区第一人民医院 150500
摘要：目的：观察抗生素滥用致耳鼻喉真菌病工作中应用不同的治疗措施的效果及对患者的治疗影响。方法：选取2017年12月～2018年12月我院收治的滥用抗生素致耳鼻喉真菌病患者29例作为研究对象，29例患者均为门诊患者,其中男15例,女14例,最大者75岁,最小者16岁,以30～50岁发病率最高,占85%。2例长期应用广谱抗生素史，所有病例均无过敏性鼻炎及哮喘史。鼻塞，流脓涕或抽吸性脓痰4例，鼻涕带血或回吸性血涕9例，从鼻腔或咽部排出褐色块状物伴有臭味5例，头痛，单侧溢泪，面颊肿痛及麻木感共1l例，多数病例经抗感染治疗症状无明显好转。29例均见上颌窦密度不均匀增高，其中15例可见斑片状或点状钙化影，其中上颌窦内侧壁骨质破坏或窦口受压扩大5例，病变主要在单侧上颌窦，而双侧仅1例．同时累及筛窦5例。结果：经过处理后,多数患者症状有不同程度改善,尤其是耳闷胀感明显减轻。结论：在抗生素滥用致耳鼻喉病中应用综合治疗，可缩短住院时间，降低住院费用及并发症的发生，提高治疗满意度。所以综合治疗是比较好的进行抗生素滥用致耳鼻喉病治疗的措施。
关键词：抗生素滥用； 治疗效果；耳鼻喉真菌病
Analysis of clinical treatment effect of 29 cases of ear, nose and throat fungal disease caused by antibiotic abuse
OBJECTIVE: To observe the effects of different therapeutic measures and the treatment effects on patients treated by antibiotic abuse. METHODS: Twenty-nine patients with antibiotic-induced otolaryngeal mycosis were enrolled in our hospital from December 2017 to December 2018. All 29 patients were outpatients, including 15 males, 14 females, and the largest 75. The oldest, the youngest is 16 years old, with the highest incidence rate of 30 to 50 years old, accounting for 85%. . Two patients had a long-term history of broad-spectrum antibiotics, and all cases had no history of allergic rhinitis and asthma. Nasal congestion, purulent sputum or aspiration pus in 4 cases, nasal discharge or sucking blood stasis in 9 cases, brown block from the nasal cavity or pharynx with odor, 5 cases, headache, unilateral tears. There were 11 cases of swollen cheeks and numbness in the cheeks. In most cases, the symptoms of anti-infective treatment did not improve significantly. In 29 cases, the density of the maxillary sinus was unevenly increased. Among them, 15 cases showed patchy or punctate calcification. Among them, 5 cases of maxillary sinus lateral wall bone destruction or sinus pressure were enlarged, and the lesion was mainly in the unilateral maxillary sinus. Only one case on both sides. At the same time involved 5 cases of ethmoid sinus RESULTS: After treatment, the symptoms of most patients improved to varying degrees, especially the swelling of the ear was significantly reduced. Conclusion: The application of comprehensive treatment in the treatment of otolaryngology caused by antibiotic abuse can shorten the length of hospital stay, reduce the cost of hospitalization and complications, and improve the satisfaction of treatment. Therefore, comprehensive treatment is a better measure for the treatment of otolaryngology caused by antibiotic abuse.
Key words: antibiotic abuse; therapeutic effect; otolaryngology mycosis引言：真菌病是由曲霉菌，念珠菌，毛霉菌等致命真菌所引起的感染[1]，耳鼻喉感染病临床上并不少见，该病有易复发的特点，临床症状多为耳肿胀伴耳鸣，部分患者有耳痒或听力下降。该病常被误认为湿疹或外耳道炎，真菌感染多为条件致病菌感染，即在一定条件下才能致病。耳鼻咽喉部位存在着有利于真菌致病的条件，如潮湿，温暖，有缝隙，很适于真菌生长。经过处理后，多数患者都有不同改善，尤其是耳闷胀感明显减轻。
资料与方法
1.1一般资料
选取2017年12月～2018年12月我院收治的抗生素滥用致耳鼻喉感染病患者29例作为研究对象，部分患者表现为耵聍栓塞,取出耵聍后见外耳道深部有粘脓性分泌物,清理外耳道后见外耳道充血、浅糜烂,鼓膜未见穿孔。
1.2方法
手术是治疗本病最有效的方法，内科治疗基本无效。29例中有20例治愈,治愈率68.9%。9例未愈(合并足部真菌感染),加用伊曲康唑间歇冲击。术中尽量保留水肿，肥厚的窦腔黏膜，因霉菌不具有角化酶，一般不会穿透完整健康的组织，且保留的窦腔黏膜不仅对真菌可能有屏障功能29例患者随访3～6个月,有12例复发,对于复发病例,除局部用哌瑞松乳膏外,仍采用上述伊曲康唑间歇冲击治疗,均得到有效控制一旦发现异常就及时的采取有效措施进行问题的解决。
2.结果
3.讨论
抗生素滥用给人们带来较为严重的威胁，极易导致患者出现头疼，单侧溢泪等症状[2]。在临床上该病的治疗效果较好。随着医疗水平不断发展，常规治疗方法得到改善，治疗工作中加强了治疗的综合性[3]。真菌病可引起严重的并发症，曾有外耳道真菌感染侵蚀颈动脉破裂、出血致死的报道。因此，合理使用抗生素应引起广大医务工作者特别是基层或社区医师的重视。术中及术后检查并冲洗窦腔是必需的，综合治疗致耳鼻喉感染中的应用具有实际意义，值得被广泛的采用。
参考文献：
[1]李丽丽，刘红刚，朴颖实，等．恶性肿瘤合并头颈部真菌感染的临床与病理学观察[J]．中华病理学杂志，2010，39(8):508－512．
[2]农辉图，李菊裳，黄光武，等．喉曲菌病[J]．中华耳鼻喉科杂志，1955，30(2):111－113．
[3]孙开宇，文霞，彭涛，等．喉真菌病三例[J]．中华耳鼻喉头颈外科杂志，2005，40(7):547－548．
论文作者:王菊颖
论文发表刊物:《医师在线（学术版）》2019年第03期
论文发表时间:2019/4/10
标签：抗生素论文; 真菌论文; 耳鼻喉论文; 患者论文; 外耳道论文; 上颌论文; 耵聍论文; 《医师在线（学术版）》2019年第03期论文;