Elsherif Abdelaziz M, Park Albert H, Alder Stephen C, Smith Marshall E, Muntz Harlan R, Grimmer F
Division of Otolaryngology/Head and Neck Surgery, University of Utah, 50 North Medical Drive, 3C 120, Salt Lake City, UT 84132, United States.
Int J Pediatr Otorhinolaryngol. 2010 Feb;74(2):198-201. doi: 10.1016/j.ijporl.2009.11.010. Epub 2009 Dec 5.
Determine clinical signs or symptoms associated with a more complicated clinical course in patients with retropharyngeal abscesses (RPAs).
Retrospective chart review at a tertiary care level Children's hospital. Main Outcome Measures Age, presenting signs and symptoms, laboratory tests, imaging results, antibiotic therapy, surgical approach, pathogens isolated, and duration of hospitalization were evaluated to determine any factors associated with a more complicated clinical course (CCC).
Fifteen of one hundred thirty pediatric patients with RPA were identified with a complicated clinical course (CCC). Eight of the fifteen required more than one procedure before the abscess resolved. Patients with multiple abscess sites had a statistically significantly greater chance of requiring multiple procedures to clear the infections (p<0.001). Another seven presented with airway obstruction requiring an admission into the Pediatric Intensive Care (PICU) and/or intubation. All the patients requiring admission to the PICU presented with signs or symptoms of airway obstruction compared to ten of the one hundred fifteen patients (8.7%) with a smooth clinical course (SCC) (p<0.001). Five patients from the CCC group required a bronchoscopy to secure the airway; seven patients required intubation following incision and drainage of the abscess for an average of 5+/-3 days. There was no statistically significant difference between the two groups with respect to pathogens isolated, or antibiotics used.
Our study suggests that patients with a CCC are more likely to present with airway obstruction or multiple abscess sites than patients with SCC.
确定与咽后脓肿（RPA）患者更复杂临床病程相关的临床体征或症状。
在一家三级护理儿童医院进行回顾性病历审查。主要观察指标评估年龄、呈现的体征和症状、实验室检查、影像学结果、抗生素治疗、手术方式、分离出的病原体以及住院时间，以确定与更复杂临床病程（CCC）相关的任何因素。
130例儿科RPA患者中有15例被确定为具有复杂临床病程（CCC）。15例中有8例在脓肿消退前需要进行不止一次手术。脓肿部位多的患者在清除感染时需要进行多次手术的可能性在统计学上显著更高（p<0.001）。另外7例出现气道阻塞，需要入住儿科重症监护病房（PICU）和/或进行插管。与115例临床病程顺利（SCC）的患者中的10例（8.7%）相比，所有需要入住PICU的患者均出现气道阻塞的体征或症状（p<0.001）。CCC组中有5例患者需要进行支气管镜检查以确保气道通畅；7例患者在脓肿切开引流后需要插管，平均插管5±3天。两组在分离出的病原体或使用的抗生素方面无统计学显著差异。
我们的研究表明，与临床病程顺利（SCC）的患者相比，具有复杂临床病程（CCC）的患者更有可能出现气道阻塞或多个脓肿部位。
