口腔颌面部多间隙感染合并化脓性心包炎的诊断与治疗

目的:总结口腔颌面部多间隙感染合并化脓性心包炎的临床特点及诊治经验。方法:2005—2010年共收治4例口腔颌面部多间隙感染合并化脓性心包炎病例,对其临床资料作回顾性分析。结果:患者均为男性,年龄27~52岁,病因均为牙源性感染。自口腔颌面部间隙感染至确诊纵隔感染0~12 d,平均6 d;纵隔感染至确诊心包炎0~7 d,平均2.5 d;治疗时间9~63 d,平均42.5 d。病原菌包括唾液链球菌、粪肠球菌、阴沟肠杆菌及嗜麦芽寡氧单孢菌等。经头颈、纵隔、心包脓肿切开引流,静脉注射抗生素,气管切开呼吸机辅助通气及全身支持治疗后,3例治愈,1例死亡。结论:口腔颌面部间隙感染导致化脓性心包炎病情凶险,而下行扩散的过程隐匿,须重视患者的胸部症状。早期诊断,及时、充分的引流是治疗关键;细菌培养对抗生素使用具有指导意义。

Diagnosis and treatment for oral and maxillofacial multiple space infections with purulent pericarditis

PURPOSE： To analyze the clinical characteristics, diagnosis and treatment of oral and maxillofacial multiple space infection with purulent pericarditis. METHODS： A total of four patients from 2005 to 2010 were included in the study. Clinical data including etiology, episode of the disease, radiology, bacteriology, treatments and outcomes were retrospectively analyzed. RESULTS： These four cases were all males, aged between 27-52 years old. They all resulted from odontogenic infection. The interval between the diagnosis of oral and maxillofacial multiple space infection and descending necrotizing mediastinitis （DNM） was 0 to 12 days （mean 6 days）,0 to 7 days from diagnosis of DNM to purulent pedcarditis （mean 2.5 days）.The hospitalization time ranged from 9 to 63 days （mean 42.5 days）. Four different pathogens were identified by pus and blood culture from three patients. Surgical drainage, tracheotomy and intravenous antibiotics were conducted. Three were cured while one died. CONCLUSION： With the characteristics of occult process and high mortality rate, diagnosis of DNM and purulent pericarditis should be taken into consideration when there is a complaint of chest pain or dyspnea in patients with oral and maxillofacial multiple space infection. Early detection and adequate drainage is the key to success. Bacterial culture plays a guiding role for antibiotic therapy.