细菌产气与颈部坏死性筋膜炎相关性研究

The relationship between bacterial gas production and necrotizing fasciitis of neck

目的比较颈部坏死性筋膜炎与其他颈部间隙感染疾病影像学检查积气征情况,探讨感染细菌产气与颈部坏死性筋膜炎的相关性。方法回顾性分析52例颈部筋膜间隙感染患者病历资料,其中颈部坏死性筋膜炎18例,均行切开清创置管引流术;非坏死性筋膜炎性颈部感染34例,行切开清创置管引流术26例,行超声引导下穿刺活检并置管引流术8例。两组患者均于术中或术后多次取脓性分泌物送细菌培养和药敏试验,所有患者术前均行颈部CT或MRI检查,并排除前期手术切开或穿刺史及颈部间隙感染已破溃情况。结果18例颈部坏死性筋膜炎患者中15例(83.3%)影像学检查有筋膜间隙积气征,34例非坏死性筋膜炎性颈部间隙感染患者中2例(5.9%)有筋膜间隙积气征,两组比较差异有统计学意义(χ^(2)=32.0842,P<0.01)。坏死性筋膜炎组中14例(77.8%)患者的细菌培养结果阳性,其中混合感染5例、链球菌13例、肺炎克雷白菌4例、金黄色葡萄球菌1例、铜绿假单胞菌1例、鲍曼不动杆菌1例;非坏死性筋膜炎组中12例(35.3%)患者细菌培养结果阳性,其中链球菌4例、肺炎克雷伯菌2例、金黄色葡萄球菌1例,凝固酶阴性葡萄球菌1例、流感嗜血杆菌1例、大肠埃希菌1例、阴沟肠杆菌1例、鲍曼不动杆菌1例。两组患者细菌培养阳性率比较差异有统计学意义(χ^(2)=8.4967,P<0.01)。除坏死性筋膜炎组1例死亡外,其他患者均治愈,随访3~6个月,均无复发。结论颈部坏死性筋膜炎积气现象明显多于其他颈部间隙感染性疾病,提示感染细菌产气可能与颈部坏死性筋膜炎的发病和发展密切相关,及早采取阻断气体产生和播散措施可能对治疗有重要意义。

Objective To compare the imaging findings of necrotizing fasciitis of the neck and other cervical space infections,and explore the relationship between the gas production of the infected bacteria and necrotizing fasciitis of the neck.Methods A retrospective study was conducted on 52 cases of cervical fascia space infection in our department from May 2015 to February 2020,including 18 cases of necrotizing fasciitis and 34 cases of non-necrotizing fasciitis.18 cases underwent incision,debridement and catheter drainage in the necrotizing fasciitis group.26 cases underwent incision,debridement and catheter drainage,and 8 cases underwent ultrasound-guided puncture biopsy and catheter drainage in the non-necrotizing fasciitis group.All cases were confirmed by operation or pathological biopsy and took purulent secretions for bacterial culture and drug sensitivity test during or after operation.All cases were examined by neck CT or MRI before operation.The previous history of surgical incision or puncture and the rupture of cervical space infection were excluded.Results In 18 cases of necrotizing fasciitis,there were 15 cases had air accumulation in the fascial space(83.3%);In 34 cases of non necrotizing fasciitis,2 cases had air accumulation in the fascial space(5.9%).There was significant difference between the two groups(χ^(2)=32.0842,P<0.01).Bacterial culture results were positive in 14(77.8%)patients with necrotizing fasciitis.There were 5 cases of mixed infection,13 cases of Streptococcus,4 cases of Klebsiella pneumoni-ae,1 case of Staphylococcus aureus,1 case of Pseudomonas aeruginosa,and 1 cases of Acinetobacter baumannii in the necrotizing fasciitis group.In the non necrotizing fasciitis group,12(35.3%)patients had positive bacterial culture results,and there were 4 Streptococcus,2 Klebsiella pneumoniae,1 Staphylococcus aureus,1 coagulase negative staphylococcus,1 Haemophilus influenzae,1 Escherichia coli,1 Enterobacter cloacae and 1 Acinetobacter baumannii in the non necrotizing fasciitis group.There was significant difference in the positive rate of bacterial culture between the two groups(χ^(2)=8.4967,P<0.01).Except one death in necrotizing fasciitis group,all other patients were cured.There was no recurrence after follow-up for 3-6 months.Conclusion The air accumulation in necrotizing fasciitis of neck is more than that in other infectious diseases of neck space.It is suggested that the gas production of bacteria may be closely related to the pathogenesis and development of necrotizing fasciitis of the neck.Early measures to block the generation and dissemination of gas may be of great significance for treatment.