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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。
Objective: To investigate the types, incidence and prognosis of serious complications of head-neck multiple space infection. Methods: A retrospective analysis of 549 cases of multiple head and neck infections between February 2006 and July 2014 was conducted, and their etiology, predisposition factors, systemic diseases, treatment methods, serious complications and treatment results were reviewed to sum up. Data were statistically analyzed using SPSS 19.0 software package. Results: Of the 549 patients with multiple head and neck infections, 66 had serious complications with a rate of 12.20%. Among them, the most were DLT (37 cases, 56.06%), followed by airway obstruction (27 cases, 40.91%), pneumonia (12 cases, 18.18%), pericarditis (6 cases, 9.09%), orbital infection 2 cases, 3.03%), multiple organ failure (2 cases, 3.03%), intracranial infection (2 cases, 3.03%) and sudden cardiac death (1 case, 1.52%). All patients with severe complications received systemic anti-infective therapy and head and neck dissection and drainage. Thirty-three patients undergoing DLT received mediastinal dissection and drainage, and 27 patients with respiratory obstruction underwent tracheotomy or endotracheal intubation. Twelve patients died during the course of treatment. Older age and patients with systemic diseases are more prone to serious complications. Conclusions: Descending mediastinitis is the most common complication of head and neck interstitial infection, and the most common cause of respiratory obstruction is death. Timely and extensive incision drainage and systemic anti-infective treatment is effective treatment of multiple head and neck infection, especially for reducing the incidence of serious complications of great significance.