549例头颈部多间隙感染严重并发症分析  

Severe complications of multi-space infections in head and neck region: A clinical study of 549 cases

作　　者：蔡协艺[1] 黄林剑[1] 姜滨[1] 张伟杰[1] 钱文涛[1] 厉婕嫣[1] 张志愿[1] 管欣[2] 梁翔[2] 周龙女[3] 朱健[3] 

机构地区：[1]上海交通大学医学院附属第九人民医院.口腔医学院口腔外科上海市口腔医学重点实验室,上海200011 [2]上海交通大学医学院附属第九人民医院胸外科,上海200011 [3]上海交通大学医学院附属第九人民医院内科,上海200011

出　　处：《中国口腔颌面外科杂志》2015年第6期539-544,共6页China Journal of Oral and Maxillofacial Surgery

基　　金：上海市卫生局科研基金(2012Y046)~~

摘　　要：目的 :探讨头颈部多间隙感染严重并发症的种类、发生率及其预后。方法 :回顾分析2006年2月—2014年7月间就诊的549例头颈部多间隙感染患者,对其病因、易感因素、伴随系统性疾病、治疗方法、严重并发症、治疗结果等进行总结。使用SPSS 19.0软件包对数据进行统计学分析。结果:549例头颈部多间隙感染患者中,66例出现严重并发症,发生率为12.20%。其中,下行性纵隔炎最多(37例,56.06%),其次为呼吸道梗阻(27例,40.91%)、肺炎(12例,18.18%)、心包炎(6例,9.09%)、眶内感染(2例,3.03%)、多器官衰竭(2例,3.03%)、颅内感染(2例,3.03%),以及心源性猝死(1例,占1.52%)。所有合并严重并发症的患者均接受全身抗感染治疗和头颈部切开引流术。其中33例下行性纵隔炎患者接受纵隔切开引流,27例呼吸道梗阻的患者接受气管切开或气管内插管。12例患者在治疗过程中死亡。高龄和有全身系统性疾病的患者更易发生严重并发症。结论:下行性纵隔炎是头颈部间隙感染最常见的并发症,而呼吸道梗阻最易导致死亡。及时广泛切开引流及全身抗感染治疗是目前治疗头颈部多间隙感染的有效方法,尤其对减少严重并发症的发生意义重大。PURPOSE ： To assess the incidence and treatment outcomes of life-threatening complications of multi-space infections （LCMI） in head and neck. METHODS ： We reviewed the medical records of a tertiary teaching hospital in Shanghai from February 2006 to July 2014. Patients with multi-space infections of head and neck were included in this study. Their demography, causes of infections, comorbidity, bacteriological studies, imaging studies, treatment regimens, life-threatening complications and outcomes were reviewed. Statistical analysis performed using SPSS 19.0 software package. RESULTS ： A total of 549 cases were included. LCMI was found in 66 patients （12.20%）. Descending mediastinitis was the most frequent LCMI （n=37, 56.06%）, followed by airway obstruction （n=27, 40.91%）, pneumonia （n=12, 18.18%）, pericarditis （n=6, 9.09%）, intraorbital infection （n=2, 3.03%）, multiple organ failure （n=2, 3.03%）, intracranial infection （n=2, 3.03%）, and sudden cardiac death （n=1, 1.52%）. All LCMI patients underwent antibiotic therapy and facial and cervical incision and drainage. In addition, mediastinal drainage was performed for 33 patients with descending mediastinitis, and 27 patients with airway obstruction underwent tracheotomy or tracheal intubation. Twelve patients died during the treatment. Elder patients and patients with comorbidity were more likely to be accompanied with LCMI. CONCLUSIONS ： Multi-space infections continue to cause life-threatening complications and significant morbidity in China. Descending mediastinitis is the most common LCMI. Airway obstruction is the most frequent cause of death. It is recommended that a prompt and aggressive surgical incision and drainage with antibiotic therapy managed by a multidisciplinary team are appropriate for multi-space infections, especially for LCMI.

关 键 词：头颈部 多间隙感染 并发症 纵隔炎 呼吸道梗阻 

分 类 号：R782.3[医药卫生—口腔医学]