159例颈深间隙感染回顾性分析

Deep neck infections: a retrospective review of 159 cases

摘要:

【摘要】目的:总结颈深间隙感染（Deep neck infention, DNI）患者的临床特点和诊疗方案。方法：收集我科2010年1月至2024年6月收治的159例DNI患者的临床资料，包括发病诱因、细菌培养结果、诊疗经过。结果：儿童最常见诱因为急性上呼吸道感染（40例，45.45%）和急性淋巴结炎（34例，38.64%），常见致病菌为金黄色葡萄球菌（12株，36.36%)，成人常见诱因为急性上呼吸道感染（25例，35.21%）和牙源性感染（21例，29.58%），常见致病菌为链球菌属（13株，46.43%）。5例患者合并下行性坏死性纵隔炎，经多学科讨论后积极性外科干预， 4例治愈，1例死亡。结论：儿童和成人DNI患者发病诱因及细菌培养各具特点，应注意区分以选择最佳治疗方案。一旦出现下行性坏死性纵隔炎，多学科讨论和积极手术干预极其重要。

Abstract:

【Abstract】 Objective: To summarize the clinical characteristics and diagnosis and treatment plan of patients with deep neck infection (DNI). Methods: The clinical data of 159 patients with DNI admitted to our department from January 2010 to June 2024 were collected, including predisposing factors, bacterial culture results, and treatment process. Results: The most common etiological factors of children were acute upper respiratory tract infection (40 cases, 45.45%) and acute lymphadenitis (34 cases, 38.64%), and the common pathogens were Staphylococcus aureus(12 strains, 36.36%). For adults, the etiological factors of acute upper respiratory tract infection (25 cases, 35.21%) and odontogenic infections (21 cases, 29.58%), and the common pathogenic bacteria were Streptococcus (13 strains, 46.43%). Five patients complicated with descending necrotizing mediastinitis(DNM).After multidisciplinary discussion,active surgical intervention was carried out,including tracheotomy or tracheal intubation,and antibiotics were given.Four patients were cured and one was dead. Conclusion: In general, the predisposing factors and bacterial culture results between children and adults with DNI are not consistent, so the clinical diagnosis and treatment should be differentiated.Once DNM occurs, septic shock needs to be prevented, multidisciplinary discussion and airway management are particularly important.