颈深部重度化脓性炎症并发脓毒症的临床诊疗与战现场诊治方式的探讨  

Series reports of clinical diagnosis and treatment of deep neck severe suppurative inflammation complicated by sepsis and discussion on its diagnosis and treatment on battlefield

作　　者：王天宇 彭浒 谢影琦 梁才全 查旭东 林柏键 蔡博宇 武舜钰 李腾飞 尹小林 刘环海 Wang Tianyu;Peng Hu;Xie Yingqi;Liang Caiquan;Zha Xudong;Lin Baijian;Cai Boyu;Wu Shunyu;Li Tenfei;Yin Xiaolin;Liu Huanhai(Department of Otolaryngology,Changzheng Hospital,Naval Medical University,Shanghai 200003,China;College of Basic Medical Sciences,Naval Medical University,Shanghai 200433,China)

机构地区：[1]海军军医大学第二附属医院耳鼻咽喉科,上海200003 [2]海军军医大学基础医学院,上海200433

出　　处：《中华航海医学与高气压医学杂志》2023年第5期629-634,共6页Chinese Journal of Nautical Medicine and Hyperbaric Medicine

基　　金：海军装备军内科研项目(HJ2020A020060);上海长征医院院级军事医学科研专项(2019CZJS207)。

摘　　要：目的探讨并总结颈深部重度化脓性炎症并发脓毒症的发病原因、临床表现、治疗方法和诊疗体会,结合战时卫生保障条件,为诊治颈部创伤后感染性疾病提供诊疗思路。方法对2018年1月至2022年1月海军军医大学第二附属医院耳鼻咽喉科收治的16例颈深部重度化脓性炎症并发脓毒症患者资料进行系列回顾,归纳整理患者一般情况、发病诱因、主要症状、影像学资料、治疗方法、病原菌培养、病程及随访情况,总结疾病特点及诊疗方案,并根据战现场颈部损伤相关报道分析战现场颈部化脓性炎症并发脓毒症的诊治措施。结果16例患者中7例合并糖尿病,其中2例未规律用降糖药故血糖控制不佳,其余9人无糖尿病病史,对比2组患者病程长短,发现糖尿病组患者病程较长,差异有统计学意义(P=0.0107)。所有患者中,大部分发病诱因为上呼吸道感染(37.50%)和咽部异物(37.50%),以外伤(12.50%)和牙源性感染(12.50%)为诱因的病例多合并糖尿病。发热(100.00%)与咽痛(68.75%)为最主要症状,除此之外,患者还存在颈部包块(18.75%)、吞咽困难(25.00%)及呼吸困难(12.50%)等表现。7例患者行穿刺引流,9例患者行切开引流。术后脓液病原菌以G+球菌最常见(包括草绿色链球菌、金黄色葡萄球菌、咽峡炎链球菌、肺炎链球菌等,占37.50%),其次是肺炎克雷伯杆菌(18.75%)。无糖尿病病史患者均无严重并发症发生,4例较严重并发症均因积极对症处理,病情得到控制。所有患者随访无1例死亡,其中14例(81.25%)治愈,2例疗效不佳患者中1例随访仍处于深昏迷状态,1例血糖控制不佳且脓肿反复的患者随访中未复发。结论颈深部重度化脓性炎症并发脓毒症因其早期症状的迷惑性和危急并发症的致死性对于临床工作考验巨大,而在战场救治的局限条件下伤员颈部创伤后继发感染的快速诊断与治疗则更具挑战性。因此通过对临�Objective To discuss and summarize the causes,clinical manifestations,treatments,as well as diagnosis and treatment experience of deep neck severe suppurative inflammation complicated by sepsis,and to provide diagnosis and treatment ideas for the diagnosing and treating post-traumatic neck infectious diseases under the conditions of medical support in wartime.Methods The medical records of 16 patients with sepsis complicated by deep neck severe suppurative inflammation treated in the department of otolaryngology of Changzheng Hospital of Naval Medical University from January 2018 to January 2022 were reviewed,including the general information,cause of onset,main symptoms,imaging data,treatments,pathogen culture,course of disease,and data of follow-up.The features of disease and diagnosis and treatment schemes were summarized.Furthermore,according to the relevant reports of neck injury on battlefield,the diagnosis and treatment measures of neck suppurative inflammation complicated by sepsis in wartime were analyzed.Results Among the 16 patients,seven complicated by diabetes,of whom two had poor blood glucose control due to irregular antidiabetic drug use;while the rest nine patients had no history of diabetes.Through comparison between the two groups,it was found that the diabetes patients had a longer disease course than the patients without diabetes,with a statistically significant difference(P=0.0107).Among all the patients,most of the cause of onset were upper respiratory tract infection(37.5%)and pharyngeal foreign body(37.5%);the cases with trauma(12.5%)and odontogenic infection(12.5%)as cause of onset were often complicated by diabetes.Fever(100%)and sore throat(68.75%)were the main symptoms.In addition,a number of patients also had neck mass(18.75%),dysphagia(25%),and dyspnea(12.5%).Seven patients underwent puncture drainage and nine patients underwent incision drainage.G+cocci were the most common pathogens in postoperative pus(including Streptococcus viridis,Staphylococcus aureus,Streptococcus pharyngiti

关 键 词：颈深部化脓性炎症 脓毒症 战现场急救 切开引流 穿刺引流 

分 类 号：R459.7[医药卫生—急诊医学]