Ni M M, Yang X H
Department of Otorhinolaryngology Head and Neck Surgery, Guizhou Provincial People's Hospital, Guiyang,550002, China.
Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2016 May 20;30(10):801-804;810. doi: 10.13201/j.issn.1001-1781.2016.10.011.
To study the etiology, presentation, diagnosis and treatment of infection of deep neck space with superior mediastinal infection in order to accumulate experience in clinical diagnosis and treatment.We reviewed medical records of 15 patients who were diagnosed with deep neck infection with superior mediastinal infection and those who were hospitalized in Guizhou provincial people's hospital from Janurary 2011 to July 2015.The patients were screened retrospectively for demographic characteristics, presenting symptoms, laboratory examinations, imaging features, bacteriologies and etiologies. The treatment and outcomes of the patients were investigated.In 15 patients, 7 cases(46.67%) were related to foreign body in esophagus, 3(20%) cases were related to peritonsillar abscess, 2(13.33%) cases who had diabetes with poor blood glucose control were related to exodontias, 3(20%) cases were related to unknown reasons. The serum CRP[(151.82±22.12)mg/L] at the time of admission had a positive correlation with the time of hospitalization. The time of CRP decreased to normal range after admission [(15.3±2.1)d] were apparently related to the hospitalization time[(23.8±4.1)d](=0.79, <0.01). The results of bacteria culture of 7 cases was positive(46.67%), 2 cases were infected by Klebsiella pneumoniae and 1 case was mixed with Escherichia coli, 2 cases were infected by the Streptococcus viridans infection, 2 cases were infected by Hemolytic streptococcus A group and B group, 1 case was infected by Staphylococcus Aureus. Appropriate antibiotics for organisms were given based on the results of culture identification and empiric therapy. The patients with abscesses were treated with cervical and superior mediastinal drainage. In 15 patients who were complex treatment, 4 patients including 2 patients with diabetes were succumbed to the disease (mortality is 26.67%),11 patients were healed up(effective rate is 73.33%).The patients with deep neck space infection with superior mediastinal infection had rapid onset, rapid development and the patients with diabetes had high mortality. The patients should be analyzed in detail the history and clinical manifestations combined with imaging examination, bacterial culture and drug sensitive test and so on in order to determine the diagnosis. The patients should be cured with effective antibiotics and active surgical intervention.
探讨颈部深部间隙感染合并纵隔感染的病因、临床表现、诊断及治疗方法,以积累临床诊治经验。回顾性分析2011年1月至2015年7月在贵州省人民医院住院治疗的15例颈部深部感染合并纵隔感染患者的病历资料。对患者的人口学特征、临床表现、实验室检查、影像学特征、细菌学及病因进行回顾性分析,并对患者的治疗及转归进行调查。15例患者中,7例(46.67%)与食管异物有关,3例(20%)与扁桃体周围脓肿有关,2例(13.33%)血糖控制不佳的糖尿病患者与拔牙有关,3例(20%)病因不明。入院时血清CRP[(151.82±22.12)mg/L]与住院时间呈正相关。入院后CRP降至正常范围的时间[(15.3±2.1)d]与住院时间[(23.8±4.1)d]明显相关(r=0.79,P<0.01)。7例细菌培养结果阳性(46.67%),其中2例为肺炎克雷伯菌感染,1例为大肠埃希菌混合感染,2例为草绿色链球菌感染,2例为A、B组溶血性链球菌感染,1例为金黄色葡萄球菌感染。根据培养鉴定结果及经验性治疗给予针对性抗生素治疗。脓肿患者行颈部及纵隔引流。15例接受综合治疗的患者中,4例死亡(病死率26.67%),其中包括2例糖尿病患者,11例治愈(有效率73.33%)。颈部深部间隙感染合并纵隔感染患者起病急、发展快,糖尿病患者病死率高。应详细分析患者病史及临床表现,结合影像学检查、细菌培养及药敏试验等以明确诊断。应给予有效的抗生素及积极的手术干预进行治疗。