儿童鼻源性眶蜂窝织炎诊疗分析

Management of nasal orbital cellulitis in children

目的 探讨儿童眶蜂窝织炎的发病特点、诊断方法及治疗原则,积累抗生素应用的治疗经验.方法 对深圳市儿童医院2009年1月至2013年12月收治的20例鼻源性眶蜂窝织炎患儿的临床资料进行回顾性分析和总结.20例患儿中,年龄2个月至7.2岁,中位数年龄3.5岁;其中男13例（65％）,女7例（35％）.分析血清C反应蛋白（C reactive protein,CRP）、白细胞计数与患儿住院天数的关系.分析头孢哌酮钠舒巴坦钠治疗组和其他抗生素治疗组的疗效差异.采用SPSS 13.0软件进行统计学分析.结果 患儿入院时的CRP平均为（29.8±22.0） mg/L,住院时间平均为（6.3±4.1）d,二者呈正相关趋势（r=0.46,P＜0.05）;入院后CRP值降至正常范围（10 mg/L）所需时间平均为（3.4±1.8）d,与住院时间呈正相关（r=0.81,P＜0.01）.入院初3d内CRP能降至正常者12例,其平均住院时间为（4.3±1.7）d,入院初3d内CRP不能降至正常者8例,其平均住院时间为（9.1±5.0）d,二者差异有统计学意义（t=2.61,P＜0.05）.头孢哌酮钠舒巴坦钠治疗组12例,其平均住院时间为（4.3±1.9）d,其他药物治疗组8例,其平均住院时间（9.3±4.7）d,差异有统计学意义（t=2.83,P＜0.05）.本组20例患者中4例脓液细菌学培养阳性,其中3例为耐甲氧西林金黄色葡萄球菌（M RSA）,1例为咽峡炎链球菌;20例患儿血培养只有1例阳性,为MRSA,与脓液培养结果一致.全部患儿经治疗后痊愈,无后遗症,无严重并发症.结论 儿童眶蜂窝织炎的早期治疗（最初3d）有效,可以缩短病程.头孢哌酮钠舒巴坦钠治疗儿童鼻源性眶蜂窝织炎有效.

Objective To analyze the clinical characteristics,diagnostic and treatment principle of orbital cellulitis in children,and to improve the experience of antibiotic treatment in orbital cellulites.Methods Twenty children were admitted to Shenzhen Children＇s Hospital with the diagnosis of nasal orbital cellulitis between January 2009 and December 2013.The children were severe enough to warrant hospital admission.There were 13（65％） males and 7 （35％）females.The median age was 3.5 years （2 months to 7.2 years）.The relationship between the serum C-reactive protein （CRP）,white blood cell count and the hospitalization days were analyzed.The children were divided into 2 groups：Cefoperazone Sodium and Sulbactam Sodium for injection group and other antibiotic treatment group,the difference was compared.Statistical calculation was performed using SPSS 13.0 software.Results The serum CRP [（29.8 ± 22.0） mg/L] at the time of admission had a positive correlation with the time of hospitalization[（6.3 ±4.1） d,r =0.46,P ＜ 0.05].The time of CRP decreased to normal range after admission [（3.4 ± 1.8） d] were apparently related to the hospitalization time （r =0.81,P ＜0.01）.The hospital days whose CRP could be decreased to normal within 3 days [n =12,（4.3 ± 1.7） d] were significantly shorter than that in the others [n =8,（9.1 ± 5.0） d,t =2.61,P ＜ 0.05].The hospitalization of 12 cases with Cefoperazone Sodium and Sulbactam Sodium for injection[（4.3 ± 1.9） d] was shorter than that in other 8 cases with other drugs [（9.3 ± 4.7） d,t =2.83,P ＜ 0.05].Bacterial pathogens were only identified in 4 children,including 3 cases of methicillin-resistant staphylococcus aureus （MRSA）,1 case of streptococcus anginosus.Only 1 case in 20 cases with positive blood culture for Staphylococcus aureus,consistented with the pus culture.Conclusions If early treatment at the first three days is valid,the course of nasal orbital cellulitis will be shorter and the orbital abscess can be prevented.Cefoperazone sulbactam and Sulbactam Sodium for injection is effective in treating pediatric orbital cellulitis.