549例头颈部多间隙感染严重并发症分析

中国口腔颌面外科杂志 ›› 2015, Vol. 13 ›› Issue (6): 539-544.

549例头颈部多间隙感染严重并发症分析

蔡协艺¹，黄林剑¹，姜滨¹，张伟杰¹，钱文涛¹，厉婕嫣¹，张志愿¹，管欣²，梁翔²，周龙女³，朱健³

1.上海交通大学医学院附属第九人民医院?口腔医学院口腔外科，上海市口腔医学重点实验室，上海 200011；
2.上海交通大学医学院附属第九人民医院胸外科，上海200011；
.上海交通大学医学院附属第九人民医院内科，上海 200011

收稿日期:2014-12-22 出版日期:2015-11-20 发布日期:2015-12-03
通讯作者: 张伟杰，Tel:021-23271699-5388,E-mail: zwj1891502@sina.com
作者简介:蔡协艺（1972-），女，博士，副主任医师，E-mail: caixieyi27@126.com
基金资助:
Supported by Scientific Research Fund of Shanghai Municipal Health Bureau (2012Y046).

Severe complications of multi-space infections in head and neck region: A clinical study of 549 cases

CAI Xie-yi¹, HUANG Lin-jian¹, JIANG Bin¹, ZHANG Wei-jie¹, Qian Wen-tao¹, LI Jie-yan¹, ZHANG Zhi-yuan¹, GUAN Xin², LIANG Xiang², ZHOU Long-nv³, ZHU Jian³.

1.Department of Oral Surgery, Shanghai Ninth People’s Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology. Shanghai 200011;
2.Department of Thoracic Surgery, 3.Department of Internal Medicine, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine. Shanghai 200011, China

Received:2014-12-22 Online:2015-11-20 Published:2015-12-03
Contact: 上海市卫生局科研基金（2012Y046）

摘要/Abstract

摘要： 目的：探讨头颈部多间隙感染严重并发症的种类、发生率及其预后。方法：回顾分析2006年2月—2014年7月间就诊的549例头颈部多间隙感染患者，对其病因、易感因素、伴随系统性疾病、治疗方法、严重并发症、治疗结果等进行总结。使用SPSS 19.0软件包对数据进行统计学分析。结果：549例头颈部多间隙感染患者中，66例出现严重并发症，发生率为12.20%。其中，下行性纵隔炎最多 (37例，56.06%)，其次为呼吸道梗阻 (27例，40.91%)、肺炎 (12例，18.18%)、心包炎 (6例，9.09%)、眶内感染 (2例，3.03%)、多器官衰竭 (2例，3.03%)、颅内感染 (2例，3.03%)，以及心源性猝死 (1例，占1.52%)。所有合并严重并发症的患者均接受全身抗感染治疗和头颈部切开引流术。其中33例下行性纵隔炎患者接受纵隔切开引流，27例呼吸道梗阻的患者接受气管切开或气管内插管。12例患者在治疗过程中死亡。高龄和有全身系统性疾病的患者更易发生严重并发症。结论：下行性纵隔炎是头颈部间隙感染最常见的并发症，而呼吸道梗阻最易导致死亡。及时广泛切开引流及全身抗感染治疗是目前治疗头颈部多间隙感染的有效方法，尤其对减少严重并发症的发生意义重大。

关键词: 头颈部, 多间隙感染, 并发症, 纵隔炎, 呼吸道梗阻

Abstract: PURPOSE : To assess the incidence and treatment outcomes of life-threatening complications of multi-space infections (LCMI) in head and neck. METHODS : We reviewed the medical records of a tertiary teaching hospital in Shanghai from February 2006 to July 2014. Patients with multi-space infections of head and neck were included in this study. Their demography, causes of infections, comorbidity, bacteriological studies, imaging studies, treatment regimens, life-threatening complications and outcomes were reviewed. Statistical analysis performed using SPSS 19.0 software package. RESULTS : A total of 549 cases were included. LCMI was found in 66 patients (12.20%). Descending mediastinitis was the most frequent LCMI (n=37, 56.06%), followed by airway obstruction (n=27, 40.91%), pneumonia (n=12, 18.18%), pericarditis (n=6, 9.09%), intraorbital infection (n=2, 3.03%), multiple organ failure (n=2, 3.03%), intracranial infection (n=2, 3.03%), and sudden cardiac death (n=1, 1.52%). All LCMI patients underwent antibiotic therapy and facial and cervical incision and drainage. In addition, mediastinal drainage was performed for 33 patients with descending mediastinitis, and 27 patients with airway obstruction underwent tracheotomy or tracheal intubation. Twelve patients died during the treatment. Elder patients and patients with comorbidity were more likely to be accompanied with LCMI. CONCLUSIONS : Multi-space infections continue to cause life-threatening complications and significant morbidity in China. Descending mediastinitis is the most common LCMI. Airway obstruction is the most frequent cause of death. It is recommended that a prompt and aggressive surgical incision and drainage with antibiotic therapy managed by a multidisciplinary team are appropriate for multi-space infections, especially for LCMI.

Key words: Head and neck, Multi-space infections, Complications, Descending mediastinitis, Airway obstruction

中图分类号:

R782.3

蔡协艺，黄林剑，姜滨，张伟杰，钱文涛，厉婕嫣，张志愿，管欣，梁翔，周龙女，朱健. 549例头颈部多间隙感染严重并发症分析[J]. 中国口腔颌面外科杂志, 2015, 13(6): 539-544.

CAI Xie-yi, HUANG Lin-jian, JIANG Bin, ZHANG Wei-jie, Qian Wen-tao, LI Jie-yan, ZHANG Zhi-yuan, GUAN Xin, LIANG Xiang, ZHOU Long-nv, ZHU Jian.. Severe complications of multi-space infections in head and neck region: A clinical study of 549 cases[J]. China J Oral Maxillofac Surg, 2015, 13(6): 539-544.

参考文献

[1] Bottin R, Marioni G, Rinaldi R, et al. Deep neck infection: a present-day complication. A retrospective review of 83 cases (1998-2001) [J]. Eur Arch Otorhinolaryngol, 2003, 260(10): 576-579.
[2] Huang TT, Liu TC, Chen PR, et al. Deep neck infection: analysis of 185 cases [J]. Head Neck, 2004, 26(10): 854-860.
[3] Ridder GJ, Technau-Ihling K, Sander A, et al. Spectrum and management of deep neck space infections: an 8-year experience of 234 cases [J]. Otolaryngol Head Neck Surg, 2005, 133(5): 709-714.
[4] Daramola OO, Flanagan CE, Maisel RH, et al. Diagnosis and treatment of deep neck space abscesses [J]. Otolaryngol Head Neck Surg, 2009, 141(1): 123-130.
[5] S?nchez R, Mirada E, Arias J, et al. Severe odontogenic infections: epidemiological, microbiological and therapeutic factors [J]. Med Oral Patol Oral Cir Bucal, 2011, 16(5): e670-676.
[6] Santos Gorj?? P, Blanco P??ez P, Morales Martín AC, et al. Deep neck infection. Review of 286 cases [J]. Acta Otorrinolaringol Esp, 2012, 63(1): 31-41.
[7] Yang SW, Lee MH, Lee YS, et al. Analysis of life-threatening complications of deep neck abscess and the impact of empiric antibiotics [J]. ORL J Otorhinolaryngol Relat Spec, 2008, 70(4): 249-256.
[8] Suehara AB, Goncalves AJ, Alcadipani FA, et al. Deep neck infection: analysis of 80 cases [J]. Braz J Otorhinolaryngol, 2008, 74(2): 253-259.
[9] Baldassari CM, Howell R, Amorn M, et al. Complications in pediatric deep neck space abscesses [J]. Otolaryngol Head Neck Surg, 2011, 144(4): 592-595.
[10] Cai XY, Zhang WJ, Zhang ZY, et al. Cervical infection with descending mediastinitis: a review of six cases [J]. Int J Oral Maxillofac Surg, 2006, 35(11): 1021-1025.
[11] Brook I. Microbiology and management of peritonsillar, retropharyngeal, and parapharyngeal abscesses[J]. J Oral Maxillofac Surg, 2004, 62(12): 1545-1550.
[12] Chang CM, Lu FH, Guo HR, et al. Klebsiella pneumoniae fascial space infections of the head and neck in Taiwan: emphasis on diabetic patients and repetitive infections[J]. J Infect,2005, 50(1): 34-40.
[13] Potter JK, Herford AS, Ellis E 3rd, et al. Tracheotomy versus endotracheal intubation for airway management in deep neck space infections [J]. J Oral Maxillofac Surg, 2002, 60(4): 349-354.
[14] Brook I. The role of anaerobic bacteria in upper respiratory tract and other head and neck infections[J]. Curr Infect Dis Rep, 2007, 9(3): 208-217.
[15] Boffano P, Roccia F, Pittoni D, et al. Management of 112 hospitalized patients with spreading odontogenic infections: correlation with DMFT and oral health impact profile 14 indexes[J]. Oral Surg Oral Med Oral Pathol Oral Radiol, 2012, 113(2): 207-213.
[16] Hasegawa J, Hidaka H, Tateda M, et al. An analysis of clinical risk factors of deep neck infection [J]. Auris Nasus Larynx, 2011, 38(1): 101-107.
[17] Tzermpos F, Iatrou I, Papadimas C, et al. Function of blood monocytes among patients with orofacial infections [J]. J Craniomaxillofac Surg, 2013, 41(2): 88-91.
[18] Yamaoka M, Ono Y, Takahashi M, et al. Acute inflammation in horizontal incompletely impacted third molar with radiolucency in the elderly [J]. Clin Interv Aging, 2009, 2009, 4: 337-342.
[19] Karkos PD, Leong SC, Beer H, et al. Challenging airways in deep neck space infections [J]. Am J Otolaryngol, 2007, 28(6): 415-418.
[20] Stalfors J, Adielsson A, Ebenfelt A, et al. Deep neck space infections remain a surgical challenge. a study of 72 patients [J]. Acta Otolaryngol, 2004, 124(10): 1191-1196.
[21] Plaza Mayor G, Martinez-San Millan J, Martinez-Vidal A. Is conservative treatment of deep neck space infections appropriate?[J]. Head Neck, 2001, 23(2): 126-133.