下行性坏死性纵隔炎临床诊疗及预后分析  

Clinical management and prognosis for descending necrotizing mediastinitis

作　　者：蔺栋鹏 王买全 侯明 彭利伟 魏文静 王广科 王永功 Lin Dongpeng;Wang Maiquan;Hou Ming;Peng Liwei;Wei Wenjing;Wang Guangke;Wang Yonggong(Department of Oral and Maxillofacial Surgery,Henan Provincial People′s Hospital,Zhengzhou University People′s Hospital,Zhengzhou 450003,China;Department of Otorhinolaryngology Head and Neck Surgery,Henan Provincial People′s Hospital,Zhengzhou University People′s Hospital,Zhengzhou 450003,China)

机构地区：[1]河南省人民医院口腔颌面外科,郑州大学人民医院,郑州450003 [2]河南省人民医院耳鼻咽喉头颈外科,郑州大学人民医院,郑州450003

出　　处：《中华耳鼻咽喉头颈外科杂志》2023年第6期565-571,共7页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

摘　　要：目的:探讨下行性坏死性纵隔炎(descending necrotizing mediastinitis,DNM)的临床特点、治疗经验及预后影响因素。方法:回顾性分析2016年1月至2022年8月在河南省人民医院诊疗的22例DNM患者资料,其中男性16例,女性6例,年龄29~79岁。患者入院后均行颌面颈胸CT连续扫描,急诊行切开引流,颈部切口使用持续负压封闭引流(vacuum sealing drainage,VSD)技术。根据预后分为治愈组和死亡组,分析预后影响因素。采用SPSS 25.0软件进行统计学分析。结果:患者主诉以吞咽困难(45.5%,10/22)和呼吸困难(50.0%,11/22)为主;牙源性感染占45.5%(10/22),口咽源性感染占54.5%(12/22)。治愈组16例,死亡组6例,总死亡率为27.3%;DNMⅠ型死亡率为16.7%,Ⅱ型死亡率为40.0%。与治愈组相比,死亡组中合并糖尿病、冠心病、感染性休克的差异均有统计学意义(P值均<0.05),2组中感染指标降钙素原(procalcitonin,PCT)和急性生理学和慢性健康状况评价Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)评分的差异有统计学意义[50.43(137.64)ng/ml比2.92(6.33)ng/ml,M(IQR),Z=3.023,P<0.05;(16.10±2.40)分比(6.75±3.19)分,xˉ±s,t=6.524,P<0.05]。结论:DNM罕见、病死率高,感染性休克、PCT值与APACHEⅡ评分增高、合并糖尿病、冠心病是DNM患者预后不良的因素。尽早切开引流与VSD技术联合使用是治疗DNM的一种较好方法。Objective To investigate the clinical characteristics,treatment experiences and prognostic factors for descending necrotizing mediastinitis(DNM).Methods A retrospective analysis was performed on the data of 22 patients with DNM diagnosed and treated in Henan Provincial People′s Hospital from January 2016 to August 2022,including 16 males and 6 females,aged 29-79 years.After admission,all patients underwent CT scanning of the maxillofacial,cervical,and thoracic regions to confirm their diagnoses.Emergency incision and drainage were performed.The neck incision was treated with continuous vacuum sealing drainage.According to the prognoses,the patients were divided into cure group and death group,and the prognostic factors were analyzed.SPSS 25.0 software was used to analyze the clinical data.Rusults The main complaints were dysphagia(45.5%,10/22)and dyspnea(50.0%,11/22).Odontogenic infection accounted for 45.5%(10/22)and oropharyngeal infection accounted for 54.5%(12/22).There were 16 cases in the cured group and 6 cases in the death group,with a total mortality rate of 27.3%.The mortality rates of DNM typeⅠand typeⅡwere respectively 16.7%and 40%.Compared with the cured group,the death group had higher incidences for diabetes,coronary heart disease and septic shock(all P<0.05).There were statistically significant differences between the cure group and the death group in procalcitonin level(50.43(137.64)ng/ml vs 2.92(6.33)ng/ml,M(IQR),Z=3.023,P<0.05)and acute physiology and chronic health evaluationⅡ(APACHEⅡ)score(16.10±2.40 vs 6.75±3.19,t=6.524,P<0.05).Conclution DNM is rare,with high mortality,high incidence of septic shock,and the increased procalcitonin level and APACHEⅡscore combined diabetes and coronary heart disease are the poor prognostic factors for DNM.Early incision and drainage combined with continuous vacuum sealing drainage technique is a better way to treat DNM.

关 键 词：感染 下行性坏死性纵隔炎 负压封闭引流 预后 

分 类 号：R564.2[医药卫生—呼吸系统]