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小儿深部颈间隙脓肿的并发症。

Complications in pediatric deep neck space abscesses.

机构信息

Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, Children's Hospital of King's Daughters, Norfolk, Virginia 23507, USA.

出版信息

Otolaryngol Head Neck Surg. 2011 Apr;144(4):592-5. doi: 10.1177/0194599810393882. Epub 2011 Feb 4.

Abstract

OBJECTIVES

To determine the incidence and demographic profile of children who develop complications from deep neck space abscess.

STUDY DESIGN

Case series.

SETTING

Tertiary children's hospital.

SUBJECTS AND METHODS

One hundred thirty-eight patients admitted for deep neck space abscesses between 1998 and 2008. Inclusion criteria were age younger than 18 years and computed tomography scan demonstrating an abscess in the retropharyngeal, parapharyngeal, or peritonsillar spaces. Children were diagnosed with abscess if purulence was encountered on operative incision and drainage.

RESULTS

In the first 5 years of the study, 45 children met the inclusion criteria, whereas in the latter 5 years, 93 children were treated for abscesses. There were no differences between these cohorts in terms of age (P = .70), gender (P = .08), abscess site (P = .23), or rate of surgical intervention (P = .83). The total major complication rate was 9.4% (n = 13) with mediastinitis being the most frequent (n = 9) complication. The number of complications between the first (n = 3) and second (n = 10) groups was not significantly different (P = .55). The factors that predisposed patients to develop complications were younger age at presentation and retropharyngeal abscess location. Children with complications were more likely to have Staphylococcus aureus identified as the causative organism (P = .007). Only 1 of 4 children with methicillin-resistant S aureus had a complicated clinical course.

CONCLUSIONS

Deep neck space abscesses continue to cause significant morbidity in children. Factors that predict complications include young age, retropharyngeal location, and S aureus. Providers must maintain a high index of suspicion to promptly diagnose and treat these complications.

摘要

目的

确定发生深部颈间隙脓肿并发症的儿童的发病率和人口统计学特征。

研究设计

病例系列研究。

设置

三级儿童医院。

研究对象和方法

1998 年至 2008 年间,共有 138 名因深部颈间隙脓肿而入院的患者符合纳入标准。纳入标准为年龄小于 18 岁,计算机断层扫描(CT)显示咽后、咽旁或扁桃体周围间隙脓肿。如果手术切开引流时遇到脓液,则诊断为脓肿。

结果

在研究的前 5 年中,有 45 名儿童符合纳入标准,而在后 5 年中,有 93 名儿童因脓肿而接受治疗。这两个队列在年龄(P =.70)、性别(P =.08)、脓肿部位(P =.23)或手术干预率(P =.83)方面没有差异。总主要并发症发生率为 9.4%(n = 13),其中最常见的并发症为纵隔炎(n = 9)。第一组(n = 3)和第二组(n = 10)的并发症数量无显著差异(P =.55)。使患者易发生并发症的因素为发病时年龄较小和咽后脓肿位置。并发症患者更有可能鉴定出金黄色葡萄球菌(S aureus)为病原体(P =.007)。耐甲氧西林金黄色葡萄球菌(MRSA)的 4 名儿童中仅有 1 人出现复杂的临床病程。

结论

深部颈间隙脓肿继续导致儿童发生严重疾病。预测并发症的因素包括年龄较小、咽后位置和金黄色葡萄球菌。医务人员必须保持高度怀疑,以便及时诊断和治疗这些并发症。

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