97例儿童眶蜂窝织炎的诊治及疗效

Clinical diagnosis, treatment and efficacy of 97 cases of pediatric orbital cellulitis

目的回顾性分析和总结儿童眶蜂窝织炎的临床特征、诊治经验，并观察临床疗效。设计回顾性病例系列。研究对象北京儿童医院收治的连续儿童眶蜂窝织炎患儿97例（106眼）。年龄为生后7天～11岁，平均年龄（11-9）个月。方法对所有患儿的病历资料进行回顾性分析，包括血常规、C反应蛋白（CRP）、血培养及药敏培养检查、眼眶及鼻窦CT影像特点等，大于4岁能配合的患儿检查视力、眼位、眼前段、眼底等。所有患眼使用抗生素点眼，口服或静脉滴注抗生素。切开排脓指征：（1）明确诊断眶隔前蜂窝织炎；（2）血白细胞计数（WBC）及CRP明显高于正常；（3）抗生素控制感染效果不佳；（4）患眼肿胀，明确触及脓肿处有波动感；（5）有眼眶CT的支持。所有切开排脓的患者均取脓液进行常规细菌培养。观察分析患儿的临床表现、实验室检查指标及疗效。主要指标临床表现、WBC、CRP、疗效、病原学检查及并发症。结果74例（76％）患儿年龄小于3岁，其中23例发病于出生后1个月内。单纯眶隔前蜂窝织炎71f11~（67％），眶蜂窝织炎35眼（33％）。有切开排脓指征的63眼（59％）患儿在全身使用抗生素下，行切开排脓引流术。术后次日血WBC由术前（23．6±9．1）x109／L降至（16．3±5．1）x109／L；CRP由术前（52±17）mg／L降至（37±12）mg／L；体温由术前（38．8±1．4）。C降至（38．2±0.4）。C。术后7～10天逐渐拔除引流条后感染症状完全控制。细菌培养结果：金黄色葡萄球菌感染者（81％）最多。最常见的并发症是球结膜脱垂及暴露性角膜炎（29例，27％）。结论眶蜂窝织炎多发生于婴幼儿。全身使用抗生素，必要时切开排脓是治疗的关键。

Objective To investigate the clinical diagnosis, treatment and efficacy of children orbital cellulitis. Design Retro- spective case series. Participants 97 cases （106 eyes） of orbital eellulitis in children with age from 7 day after birth to 11-year old （av- erage 11＋9 months）. Methods All of the patients underwent the following examinations： orbit and paranasal sinus computed tomography （CT）, blood routine test, C reactive protein （CRP）, blood culture and drug sensitivity. Visual acuity, eye position, anterior segment, fun- dus examination were examed for cooperative children older than 4 years. All the patients were treated with antibiotic eyedrops, oral or intravenous antibiotics. Indication of incision and drainage： （1） definite diagnosis of preorbital cellulitis; （2） white blood cells （WBC） and CRP much higher than normal; （3） antibiotics cannot control the infection; （4） eyelid swelling and fluetuant feeling of the abscess; （5） support of orbital CT. C-ermicuhures were performed after the incision and drainage. Then clinical manifestations, WBC, CRP, and the efficacy, etiological examination, and complications were observed and analysed. Main Outcome Measures Clinical manifestations, WBC, CRP, and the efficacy, etiological examination, and complications. Results 74 cases （76%） were younger than 3-year old, of which 23 cases were within 1 month after birth. 71 eyes （67%） manifested as preorbital eellulitis and 35 eyes （33%） as orbital cellulitis. 63 eyes （59%） with the indications underwent the operation of incision and drainage on top of using systemic antibiotics. WBC, CRP and body temperature was （23.6±9.1） ×10^9/L, （52±17） mg/L, and （38.8±1.4） ℃ before treatment, which decreased to （16.3±5.1）×10^9/L, （37± 12）mg/L, and （38.2±0.4）℃ respectively at first day after the drainage. Infection symptoms were completely controlled after removal of the drainage strip 7-10 days postoperatively. Staphylococcus aureus was the most common pathogen （81%）. And conjunctival pro- lapse and exposure keratitis were the most commom complications （27%）. Conclusion The incidence of orbital cellulitis often happened in infants. A combination of systemic antibiotic, incision and drainage works well to control the sympotoms of children orbital cellulitis.