儿童咽后脓肿的临床特征与治疗
Clinical features and treatment of retropharyngeal abscess in children.
作者信息
Page Nathan C, Bauer Erik M, Lieu Judith E C
机构信息
Department of Otolaryngology, Washington University School of Medicine, St Louis, MO 63110, USA.
出版信息
Otolaryngol Head Neck Surg. 2008 Mar;138(3):300-6. doi: 10.1016/j.otohns.2007.11.033.
OBJECTIVE
To characterize presentation, treatment, and outcomes of pediatric retropharyngeal abscess (RPA) and determine optimal treatment.
STUDY DESIGN
Retrospective cohort.
SUBJECTS AND METHODS
Chart review of 162 pediatric patients with RPA.
RESULTS
Initial treatment was surgery in 126 and intravenous antibiotics in 36, of which 17 required surgery. Findings were negative in 30, murky fluid in 34, and pus in 79. Factors predicting positive surgical drainage were duration of symptoms for more than 2 days, prior antibiotic treatment, and CT lesion cross-sectional area >2.0 cm(2). A history of rash was a negative predictor. The mean length of stay (LOS) was 4.8 vs 3.6 days (P = 0.14), and duration of fever (DOF) was 2.5 vs 1.4 days (P = 0.01) for patients with no fluid and fluid at surgery, respectively. For antibiotic vs surgery groups, LOS was 4.4 vs 3.6 days (P = 0.14) and DOF was 2.4 versus 1.5 days (P = 0.0061).
CONCLUSIONS
These predictive factors may be useful in selecting patients with retropharyngeal abscesses who might be treated with intravenous antibiotics alone.
目的
描述小儿咽后脓肿（RPA）的临床表现、治疗方法及预后，并确定最佳治疗方案。
研究设计
回顾性队列研究。
研究对象与方法
对162例小儿RPA患者的病历进行回顾。
结果
126例患者初始治疗采用手术，36例采用静脉抗生素治疗，其中17例后来需要手术。30例检查结果为阴性，34例为浑浊液体，79例为脓液。预测手术引流阳性的因素包括症状持续超过2天、先前使用过抗生素治疗以及CT病变横截面积>2.0 cm²。有皮疹病史是阴性预测因素。手术时无液体和有液体的患者，平均住院时间（LOS）分别为4.8天和3.6天（P = 0.14），发热持续时间（DOF）分别为2.5天和1.4天（P = 0.01）。抗生素治疗组与手术组相比，LOS为4.4天和3.6天（P = 0.14），DOF为2.4天和1.5天（P = 0.0061）。
结论
这些预测因素可能有助于选择仅用静脉抗生素治疗的小儿咽后脓肿患者。
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