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[颈部深部感染:病因、细菌学与治疗]

[Deep neck infections: etiology, bacteriology and treatment].

作者信息

Regueiro Villarín S, Vázquez Barro J C, Herranz González-Botas J

机构信息

Servicio de Otorrinolaringología Hospital Universitario Juan Canalejo, A Coruña.

出版信息

Acta Otorrinolaringol Esp. 2006 Aug-Sep;57(7):324-8. doi: 10.1016/s0001-6519(06)78720-9.

Abstract

Deep neck infections are dangerous for its potential ease to fascial spread, sepsis, and upper airway obstruction. This article reviews 77 cases of deep cervical infection, focus on etiological, clinical and therapeutic aspects. The most frequent location was the submaxillary area (29%), followed by the parapharyngeal space (28%), floor of the mouth (27%) and retropharyngeal (14%) spaces. Etiology was dental in 32%; pharyngoamigdalar infection in 27%; foreign bodies in 13%. In 22% the cause is unknown. Two or more bacteria were isolated in 72%, with Streptococcus B haemolytic being the most frequent germ. All patients were treated with intravenous broad-spectrum antibiotics. Surgical drainage was needed in 54%, and tracheotomy in 18%. Four patients developed mediastinitis, and one died as a consequence of it. The incidence of deep neck infections has decreased after the itroduction of antibiotics but they still may be lethal especially when life-threatening complications occur. Early recognition and management are necessary.

摘要

深部颈部感染因其易于向筋膜扩散、引发败血症及导致上呼吸道梗阻而十分危险。本文回顾了77例深部颈部感染病例,重点关注病因、临床及治疗方面。最常见的部位是颌下区(29%),其次是咽旁间隙(28%)、口底(27%)和咽后间隙(14%)。病因方面,牙源性占32%;咽扁桃体感染占27%;异物占13%。22%的病例病因不明。72%的病例分离出两种或更多细菌,其中B型溶血性链球菌最为常见。所有患者均接受静脉广谱抗生素治疗。54%的患者需要手术引流,18%的患者需要气管切开。4例患者发生纵隔炎,1例因此死亡。抗生素应用后深部颈部感染的发生率有所下降,但仍可能致命,尤其是出现危及生命的并发症时。早期识别和处理很有必要。

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