Purpose: Descending necrotizing mediastinitis(DNM) is a lethal and acute suppurative disease. This report aimed to summarize our experience in the treatment of DNM with continuous negative pressure catheter drainage a...Purpose: Descending necrotizing mediastinitis(DNM) is a lethal and acute suppurative disease. This report aimed to summarize our experience in the treatment of DNM with continuous negative pressure catheter drainage and transnasal jejunal feeding by interventional techniques. Materials and Methods: We retrospectively analyzed relevant clinical data of patients with DNM who underwent continuous negative pressure catheter drainage and transnasal jejunal feeding. All drainage catheters and jejunal feeding tubes were inserte d by interventional techniques. Results: In total, 21 patients were diagnosed with DNM by esophagography and computed tomography(CT). Catheters for the drainage of mediastinal abscesses as well as transnasal jejunal feeding tubes were successfully placed in all patients, indicating a 100% success rate. Of all patients, 13 underwent insertion of abscess drainage catheters through percutaneous puncture under DynaCT guidance, while eight had drainage catheter insertion through fistula orifices in the posterior nasopharyngeal wall or esophagus under fluoroscopic guidance. In total, 26 drainage tubes were inserted. One patient with diabetes died of sepsis and diabetic ketoacidosis 5 days postoperatively, while the remaining 20 patients showed good recovery with successful removal of the drainage catheters. Durations of catheterization were 45.2±50.44 days. The overall clinical success rate was 95.2%. Conclusion: The above described methods are non-surgical, minimally invasive and efficacious, and may be alternative therapeutic tools for patients who are not eligible for surgical operation, have a high postoperative risk, or are more likely to choose minimally invasive techniques.展开更多
目的:比较改良早期预警评分(modified early warning score,MEWS)与修正MEWS在下行性坏死性纵隔感染患者中的应用价值。方法:回顾性分析上海交通大学医学院附属第九人民医院胸外科2018年7月-2019年12月收治的65例下行性坏死性纵隔感染...目的:比较改良早期预警评分(modified early warning score,MEWS)与修正MEWS在下行性坏死性纵隔感染患者中的应用价值。方法:回顾性分析上海交通大学医学院附属第九人民医院胸外科2018年7月-2019年12月收治的65例下行性坏死性纵隔感染患者的临床资料,以患者是否发展为重症作为观察指标,分别用MEWS与修正MEWS对患者进行评估,比较2种评分方法评估患者疾病严重程度及预后的灵敏度及特异度。采用SPSS 22.0软件包对数据进行统计学分析。结果:2种评分表在对患者疾病严重程度的预测能力上均具有中等程度的分辨度,修正MEWS评分显著高于MEWS评分(Z=2.257,P=0.024),MEWS的ROC曲线下面积为0.669(95%<:CI:0.538~0.800,P=0.023),修正MEWS的KOC曲线下面积为0.818(95%CI:0.718~0.917,P=0.000).结论:修正MEWS能更有效地反映患者人院时病情危重程度,有利于医护人员早期发现患者潜在的病情风险,及时做好应急处置,保证护理安全,具有重要的临床意义。展开更多
文摘Purpose: Descending necrotizing mediastinitis(DNM) is a lethal and acute suppurative disease. This report aimed to summarize our experience in the treatment of DNM with continuous negative pressure catheter drainage and transnasal jejunal feeding by interventional techniques. Materials and Methods: We retrospectively analyzed relevant clinical data of patients with DNM who underwent continuous negative pressure catheter drainage and transnasal jejunal feeding. All drainage catheters and jejunal feeding tubes were inserte d by interventional techniques. Results: In total, 21 patients were diagnosed with DNM by esophagography and computed tomography(CT). Catheters for the drainage of mediastinal abscesses as well as transnasal jejunal feeding tubes were successfully placed in all patients, indicating a 100% success rate. Of all patients, 13 underwent insertion of abscess drainage catheters through percutaneous puncture under DynaCT guidance, while eight had drainage catheter insertion through fistula orifices in the posterior nasopharyngeal wall or esophagus under fluoroscopic guidance. In total, 26 drainage tubes were inserted. One patient with diabetes died of sepsis and diabetic ketoacidosis 5 days postoperatively, while the remaining 20 patients showed good recovery with successful removal of the drainage catheters. Durations of catheterization were 45.2±50.44 days. The overall clinical success rate was 95.2%. Conclusion: The above described methods are non-surgical, minimally invasive and efficacious, and may be alternative therapeutic tools for patients who are not eligible for surgical operation, have a high postoperative risk, or are more likely to choose minimally invasive techniques.
文摘目的:比较改良早期预警评分(modified early warning score,MEWS)与修正MEWS在下行性坏死性纵隔感染患者中的应用价值。方法:回顾性分析上海交通大学医学院附属第九人民医院胸外科2018年7月-2019年12月收治的65例下行性坏死性纵隔感染患者的临床资料,以患者是否发展为重症作为观察指标,分别用MEWS与修正MEWS对患者进行评估,比较2种评分方法评估患者疾病严重程度及预后的灵敏度及特异度。采用SPSS 22.0软件包对数据进行统计学分析。结果:2种评分表在对患者疾病严重程度的预测能力上均具有中等程度的分辨度,修正MEWS评分显著高于MEWS评分(Z=2.257,P=0.024),MEWS的ROC曲线下面积为0.669(95%<:CI:0.538~0.800,P=0.023),修正MEWS的KOC曲线下面积为0.818(95%CI:0.718~0.917,P=0.000).结论:修正MEWS能更有效地反映患者人院时病情危重程度,有利于医护人员早期发现患者潜在的病情风险,及时做好应急处置,保证护理安全,具有重要的临床意义。
