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脊柱硬膜外脓肿临床综述:面向急诊医学和住院医师的流行病学、病理生理学、诊断及管理

A Clinical Review on Spinal Epidural Abscess: Epidemiology, Pathophysiology, Diagnosis, and Management for Emergency Medicine and Hospitalist Physicians.

作者信息

Guy Madeline A, Guy Jeffrey S

机构信息

Northeastern Ohio Medical University, College of Medicine, Rootstown, OH.

HCA Healthcare Clinical Services Group, Nashville, TN.

出版信息

HCA Healthc J Med. 2024 Aug 1;5(4):397-404. doi: 10.36518/2689-0216.1676. eCollection 2024.

Abstract

Description Spinal epidural abscess (SEA), a critical surgical emergency, demands prompt recognition and intervention to prevent severe complications and fatalities. The incidence of SEA is notably increasing, particularly among individuals with diabetes, intravenous drug use, or a history of invasive spinal procedures. Although SEA can manifest through various clinical symptoms, the presence of its classic triad-back pain, fever, and neurological deficits-is noteworthy despite its occurrence in only 10% to 13% of cases. Identifying this triad is vital due to its high specificity for SEA, which is essential to guiding swift diagnostic and therapeutic actions in a condition where early intervention is critical. Magnetic resonance imaging is pivotal in diagnosing SEA, offering unmatched sensitivity and specificity compared to other imaging techniques. Immediate empirical antibiotic therapy and timely neurosurgical consultation, when required, form the foundation of SEA treatment. The prognosis significantly depends on the patient's initial neurological status, underlying health conditions, and the timeliness of their presentation, diagnosis, and treatment initiation. Given the complexity of SEA and the high risk of diagnostic delays, managing this condition involves substantial medicolegal considerations. Enhanced comprehension of SEA is imperative for improving patient outcomes and reducing health care resource burdens. Prompt and accurate diagnosis and appropriate interventions are essential for effectively managing this urgent condition.

摘要

描述 脊髓硬膜外脓肿(SEA)是一种严重的外科急症,需要迅速识别和干预以预防严重并发症和死亡。SEA的发病率显著上升,尤其是在糖尿病患者、静脉吸毒者或有脊柱侵入性手术史的人群中。虽然SEA可通过多种临床症状表现出来,但其典型三联征——背痛、发热和神经功能缺损——的出现值得关注,尽管仅10%至13%的病例会出现该三联征。识别此三联征至关重要,因为其对SEA具有高度特异性,这对于在早期干预至关重要的情况下指导快速诊断和治疗行动必不可少。与其他成像技术相比,磁共振成像在诊断SEA方面起着关键作用,具有无与伦比的敏感性和特异性。立即进行经验性抗生素治疗,并在需要时及时进行神经外科会诊,是SEA治疗的基础。预后很大程度上取决于患者的初始神经状态、基础健康状况以及就诊、诊断和开始治疗的及时性。鉴于SEA的复杂性和诊断延误的高风险,管理这种疾病涉及大量法医学考量。增强对SEA的理解对于改善患者预后和减轻医疗资源负担至关重要。迅速准确的诊断和适当的干预对于有效管理这种急症至关重要。

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本文引用的文献

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