颈深部合并上纵隔感染的临床诊疗分析

The clinical analysis of infection of the deep neck space with superior mediastinal abscess

目的:探讨颈深部合并上纵隔感染的病因及发病特点、诊断方法及治疗原则,为临床诊疗提供借鉴。方法:对我院2011-01-2015-06期间收治的15例颈深部合并上纵隔感染的患者临床资料进行回顾性分析和总结,分别对其临床特征、全身系统检查、实验室检查、影像学特征及微生物学检查进行整理分析,归纳病因,并追踪临床诊疗和预后。结果:15例患者中7例因"食管异物"、3例因"扁桃体周围脓肿"、2例因"拔牙"、3例不明原因导致感染。2例拔牙患者中均有糖尿病,且血糖控制不佳。患者入院时C反应蛋白(CRP)平均值为(151.82±22.12)mg/L,CRP值降至正常范围所需时间为(15.3±2.1)d,与住院时间(23.8±4.1)d呈正相关(r=0.79,P<0.01)。7例患者细菌培养阳性(阳性率为46.67%),其中肺炎克雷伯菌肺炎亚种2例,其中1例合并大肠埃希菌感染,草绿色链球菌2例,溶血性链球菌非A群和B群2例,金黄色葡萄球菌1例。在针对病因治疗同时,对于脓肿形成的患者行颈深部脓肿及纵隔脓肿切开引流术,结合药物敏感试验,给予相应的抗生素抗感染治疗,若细菌培养阴性的患者,给予经验抗生素治疗。经过积极的综合治疗后,15例患者中死亡4例,其中2例为糖尿病患者(死亡率为26.67%),痊愈11例(有效率为73.33%)。结论:颈深部间隙感染并发纵隔感染起病急,进程快,合并糖尿病者预后差。临床诊治上应详细分析病史及临床表现,结合影像学检查、细菌培养及药物敏感试验等检查,以明确诊断,及时使用有效抗生素,并积极给予外科干预。

Objective：To study the etiology,presentation,diagnosis and treatment of infection of deep neck space with superior mediastinal infection in order to accumulate experience in clinical diagnosis and treatment.Method：We reviewed medical records of 15 patients who were diagnosed with deep neck infection with superior mediastinal infection and those who were hospitalized in Guizhou provincial people＇s hospital from Janurary 2011 to July 2015.The patients were screened retrospectively for demographic characteristics,presenting symptoms,laboratory examinations,imaging features,bacteriologies and etiologies.The treatment and outcomes of the patients were investigated.Result：In 15 patients,7cases（46.67%）were related to foreign body in esophagus,3（20%）cases were related to peritonsillar abscess,2（13.33%）cases who had diabetes with poor blood glucose control were related to exodontias,3（20%）cases were related to unknown reasons.The serum CRP[（151.82±22.12）mg/L]at the time of admission had a positive correlation with the time of hospitalization.The time of CRP decreased to normal range after admission[（15.3±2.1）d]were apparently related to the hospitalization time[（23.8±4.1）d]（r=0.79,P〈0.01）.The results of bacteria culture of 7cases was positive（46.67%）,2cases were infected by Klebsiella pneumoniae and 1case was mixed with Escherichia coli,2cases were infected by the Streptococcus viridans infection,2cases were infected by Hemolytic streptococcus A group and B group,1case was infected by Staphylococcus Aureus.Appropriate antibiotics for organisms were given based on the results of culture identification and empiric therapy.The patients with abscesses were treated with cervical and superior mediastinal drainage.In 15 patients who were complex treatment,4patients including 2patients with diabetes were succumbed to the disease（mortality is 26.67%）,11 patients were healed up（effective rate is 73.33%）.Conclusion：The patients with deep neck space infection with superior mediastinal infection had rapid onset,rapid development and the patients with diabetes had high mortality.The patients should be analyzed in detail the history and clinical manifestations combined with imaging examination,bacterial culture and drug sensitive test and so on in order to determine the diagnosis.The patients should be cured with effective antibiotics and active surgical intervention.