Juang Y C, Cheng D L, Wang L S, Liu C Y, Duh R W, Chang C S
Department of Medicine, Veterans General Hospital, Taipei, Taiwan, Republic of China.
Scand J Infect Dis. 1989;21(2):121-5. doi: 10.3109/00365548909039957.
Ludwig's angina remains a potentially lethal disease entity as it causes rapidly progressive airway obstruction, although the current mortality rate is low. Early surgical intervention should be carried out in severe cases which show signs of fluctuation, abscess formation or other serious complications. We report our experience with 14 cases of Ludwig's angina, 12 of which (86%) were of dental origin. Only one case was complicated with Klebsiella pneumoniae septicemia which resolved upon treatment. There were no deaths. Surgical procedures including incision and drainage and tooth extraction were performed in 11 cases (78%). Antibiotics were administered to all patients. Most of them were treated with crystalline penicillin with or without an aminoglycoside. Only one patient received a tracheostomy in this series. The number of tracheostomies or intubations carried out was much lower than in previous reports. We suggest that an aggressive antimicrobial therapy, early surgical intervention and careful monitoring of the respiratory symptoms would reduce both the need for tracheostomy and the mortality rate.
路德维希咽峡炎仍然是一种潜在的致命疾病，因为它会导致快速进展的气道梗阻，尽管目前的死亡率较低。对于出现波动迹象、脓肿形成或其他严重并发症的严重病例，应尽早进行手术干预。我们报告了14例路德维希咽峡炎的治疗经验，其中12例（86%）起源于牙科。只有1例并发肺炎克雷伯菌败血症，经治疗后痊愈。无死亡病例。11例（78%）患者接受了包括切开引流和拔牙在内的外科手术。所有患者均使用了抗生素。大多数患者接受了结晶青霉素治疗，联合或不联合氨基糖苷类药物。本系列中只有1例患者接受了气管切开术。气管切开术或插管的数量远低于既往报告。我们建议，积极的抗菌治疗、早期手术干预以及对呼吸道症状的密切监测将减少气管切开术的需求和死亡率。
