凶险型颈深部间隙脓肿致呼吸心搏骤停诊治体会

Diagnosis and treatment of respiratory cardiac arrest caused by dangerous deep neck abscess

山东第一医科大学附属青州医院于2021年1月5日收治1例凶险型颈深部间隙脓肿合并颈静脉血栓致呼吸心搏骤停患者。患者男性,45岁,咽部疼痛2周,发热4 d,发现颈静脉血栓2 h住血管外科,入科50 min后,突发寒战、抽搐、二便失禁,继之呼吸和心搏骤停。初步诊断:心搏骤停后综合征、肺栓塞待诊、右侧颈内静脉血栓。心肺复苏和抗凝治疗后转入重症监护病房(ICU),给予呼吸机辅助机械通气、维持循环功能、哌拉西林舒巴坦预防感染等对症支持治疗。第2天患者体温38.3℃,右侧颌下部皮肤红肿伴皮温度高。血常规化验:白细胞计数(WBC)19.2×10^(9)/L,中性粒细胞比例(NEUT)92.5%,降钙素原(PCT)39μg/L。生命体征基本稳定后行颈及胸部强化CT:右颈动脉间隙脓肿;肺动脉CT血管成像(CTA):排除肺动脉栓塞。最后诊断:颈深部间隙脓肿、心搏骤停后综合征、右侧颈内静脉血栓。在治疗上给予美罗培南+利奈唑胺广覆盖抗感染治疗,同时行血液细菌培养、药敏试验,根据血液细菌培养结果调整抗菌药物;在B超引导定位下行右侧颈动脉间隙脓肿穿刺引流;1月12日脓肿局限后行切开引流;第17天成功拔出气管导管;住院49 d后痊愈出院。

A patient with an aggressive deep neck interstitial abscess combined with jugular vein thrombosis resulting in respiratory cardiac arrest was admitted to Qingzhou Hospital Affiliated to the First Medical University of Shandong Province on January 5,2021.The patient was a 45 year old male with pharyngeal pain for 2 weeks and fever for 4 days.He found jugular vein thrombosis for 2 hours and was admitted to the department of vascular surgery.Fifty minutes after admission,he had sudden chills,convulsions,second fecal incontinence,followed by respiratory and cardiac arrest.The initial diagnosis was:post-cardiac arrest syndrome,pulmonary embolism pending diagnosis,and right internal jugular vein thrombosis.After cardiopulmonary resuscitation and anticoagulation treatment,he was transferred to the intensive care unit(ICU)and given other symptomatic support treatment,such as using a ventilator,maintaining circulatory function,and prescribing piperacillin sulbactam for infection prevention.On the second day,the patient's body temperature was 38.3℃.The skin on the right side of the lower jaw was red and swollen with high skin temperature.The blood routine showed:white blood cell count(WBC)19.2×10^(9)/L,neutrophil percentage(NEUT)92.5%,procalcitonin(PCT)39 ng/mL.After the patient's vital life signs were stabilized,enhanced CT of the neck and chest was permormed which showed a right interstitial abscess;a computed tomography angiography(CTA)of the pulmonary artery ruled out pulmonary artery embolism.The final diagnosis:deep cervical interstitial abscess,post-cardiac arrest syndrome,and right internal jugular vein thrombosis.In terms of treatment,meropenem plus linezolid were given for wide coverage of anti-infection.Meanwhile,blood bacterial culture and drug sensitivity tests were carried out,and antibiotics were adjusted according to the results of blood bacteria.The right carotid artery interstitial abscess was punctured and drained under ultrasound guidance,and as the abscess become confined.We drained it by incision on January 12.On the 17th day,the tracheal tube was successfully removed.The patient was discharged after 49 days of hospitalization.