儿童眶周和眼眶蜂窝织炎的临床分析

Clinical analysis of periorbital and orbital cellulitis in Children

目的:探讨儿童眶周和眼眶蜂窝织炎的临床特点及治疗方法。方法:对2010年本院收治的54例眶周和眼眶蜂窝织炎患儿的临床资料进行回顾性研究。结果:儿童眶周蜂窝织炎34例,眼眶蜂窝织炎20例,平均男女比例2.6∶1,3岁以下发病比例达71%。两者发病季节高峰分别在11月份和1月份,发病原因多样化。眶周蜂窝织炎的外周血白细胞计数、中性粒细胞计数及血清C反应蛋白(CRP)升高比例低于眼眶蜂窝织炎,差异有统计学意义(P<0.01)。57%眶周蜂窝织炎和88%眼眶蜂窝织炎患儿CT检出鼻窦炎。眼部脓肿的脓液培养得到金黄色葡萄球菌、模仿葡萄球菌和肺炎链球菌。眶周蜂窝织炎可用单一或二联抗生素治疗,眼眶蜂窝织炎常需抗生素联合用药,必要时实行手术。结论:儿童眶周蜂窝织炎和眼眶蜂窝织炎的发病年龄集中在3岁以下,秋冬季为高发季节,上呼吸道感染和鼻窦炎是主要病因。眼眶蜂窝织炎比眶周蜂窝织炎感染重,CT有利于临床诊断,抗生素应覆盖葡萄球菌和链球菌,并根据病因和微生物学检查调整用药,在适宜时期实行手术可以加快治愈并减少复发。

AIM：To analyze clinical characteristics of periorbital and orbital cellulitis in pediatrics. METHODS：Fifty-four medical records of pediatrics admitted to the Department of Ophthalmology with a diagnosis of periorbital and orbital cellulitis during the year 2010 were retrospectively studied. RESULTS：Thirty-four cases of periorbital cellulitis and 20 cases of orbital cellulitis were included, with no significant differences in gender, eye involvement and age between the two. Male∶female ratio was 2.6∶1, The highest incidence occurred in the 0-3 year old group（71%）. Seasonal distribution appeared to peak in November and January, the predisposing factors were diverse. White blood cell count, neutrophil count and percentage of elevated C-reactive protein in periorbital cellulitic patients were lower than those in orbital cellulitic patients（P0.01）.57% periorbital and 88% orbital cellulitic children were found sinusitis by orbital and sinus CT scans. The isolated pathogens found in pediatric orbital abscess fluid included Staphylococcus aureus, Staphylococcus simulans and Streptococcus pneumoniae.Periorbital cellulitic children were treated with single or two antibiotics, while orbital cellulitis usually required combined antibiotics, and surgical interventions when necessary. CONCLUSION：Children with periorbital or orbital cellulitis are commonly under three years old, seasonal incidence peaks in autumn and winter, upper respiratory infection and sinusitis are the most important predisposing factors. Orbital cellulitis has a more severe infection than periorbital cellulitis, CT scan is useful to differential diagnosis.Antibiotic therapy should have coverage against staphylococcal and streptococcal species, and adjust to different predisposing diseases and microbiology. A timely performed surgery can shorten the course of infection and decrease recurrence.