549例头颈部多间隙感染严重并发症分析

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。     

重症口腔颌面头颈部多间隙感染临床分类探讨

目的 ：探讨一种新的口腔颌面头颈部多间隙感染临床分类方法。方法 ：回顾攀枝花市中心医院2015年7月—2022年3月采用全麻手术治疗的120例重症口腔颌面头颈部多间隙感染患者的临床及影学资料,探讨一种新的分类方法。采用SPSS 17.0软件包对数据进行统计学分析。结果：重症口腔颌面头颈部多间隙感染可分为5类。Ⅰ类82例（68.33%）,感染集中在舌骨-颧弓平面范围,通过下颌下切口能充分引流各间隙感染;Ⅱ类13例（10.83%）,感染向上波及颞深间隙,需行下颌下及颞部2个切口充分引流;Ⅲ类14例（11.67%）,感染向下波及锁骨以上的颈下部间隙,需行下颌下及锁骨上切口充分引流;Ⅳ类5例（4.17%）,感染波及颞部到锁骨上范围,需结合下颌下、颞部及锁骨上多个切口引流;Ⅴ类6例（5%）,感染突破锁骨平面波及纵隔、胸腔,必须联合心胸外科行纵隔及胸腔引流。从Ⅰ类到Ⅴ类患者病情逐渐加重,治疗难度逐渐递增,风险逐渐提高,平均ICU监护时长、住院时长、住院花费及抗菌药费用等医疗资源消耗也逐渐增加（P<0.0001）。结论：重症口腔颌面头颈部多间隙感染危及生命,多学科联合是治疗的前提。对该病进行合...     

头颈部手术后谵妄危险因素的meta分析

目的: 分析头颈部手术后谵妄危险因素,为临床有效预防术后谵妄提供依据。方法: 通过计算机检索PubMed、Cochrane library、EMBASE、ISI Web of Knowledge、Google scholar、CNKI数据库、维普数据库和万方数据库,查找关于头颈部手术后谵妄危险因素的文献,截止日期为2014年1月。采用RevMan5.2软件进行统计学分析。结果: 共纳入7篇关于头颈部手术患者术后谵妄危险因素的病例对照研究,共有1664例患者行头颈部手术,谵妄组237例,非谵妄组1427例。研究结果表明,年龄（WMD:5.70,95% CI:1.96-9.43,P<0.001）、性别（OR:1.51,95% CI:1.07-2.12,P<0.05）、独居（OR:2.22,95% CI:1.42-3.48,P<0.001）、术前精神疾病（OR:2.57,95% CI:1.60-4.15,P<0.05）、酗酒（OR:1.74,95% CI:1.79-2.54,P<0.05）及手术麻醉时间（WMD:63.93,95% CI:9.47-118.38,P<0.05）等6项为头颈部手术患者术后谵妄相关因素;而与根治性颈淋巴清扫术、游离皮瓣修复、气管切开、术后制动等因素无显著相关性（P>0.05）。结论: 患者年龄、性别、独居、术前精神疾病、酗酒及手术麻醉时间等6项为头颈部手术患者术后谵妄的危险因素。     

影响糖尿病患者口腔颌面部多间隙感染治疗结果的因素分析

目的:分析影响口腔颌面部多间隙感染患者治疗结果 (住院天数和并发症)的转归因素,并比较糖尿病患者与非糖尿病患者口腔颌面部多间隙感染的临床特征。方法:对2007—2010年间收治的117例口腔颌面部多间隙感染病例进行回顾分析。研究变量包括一般资料、病因学、临床指标(症状发作到入院治疗的时间、受累间隙的种类和数量)和实验室检查(细菌学、入院时血糖水平、入院时血白细胞总数和中性粒细胞百分比),结果变量为患者住院天数和并发症。采用SAS8.0软件包对数据进行t检验、卡方检验、方差分析、Logistic回归和线性回归分析。结果:糖尿病口腔颌面部多间隙感染患者与非糖尿病患者相比,前者受累的间隙更多,住院时间更长,全身各种并发症情况更多见,严重者可导致死亡。糖尿病存在与否与口腔颌面部多间隙感染的治疗转归(住院时日和并发症)直接相关。入院时血糖水平是影响口腔颌面部多间隙感染并发症严重程度的主要因素。结论:糖尿病患者与非糖尿病患者口腔颌面部多间隙感染的临床特征和转归不同,为临床上治疗糖尿病口腔颌面部多间隙感染提供了重要的参考依据。     

516例头颈部恶性肿瘤根治术后谵妄危险因素分析

目的评估头颈部恶性肿瘤根治术后谵妄的危险因素，为临床制定术后谵妄防治的应对措施提供依据。 方法本研究为回顾性队列研究，纳入2018年10月1日至2021年10月1日于徐州中心医院和上海交通大学医学院附属第九人民医院口腔颌面外科接受头颈恶性肿瘤手术的患者共516例，其中男328例、女188例。对相关危险因素和生命体征进行了回顾和收集。依据谵妄评估量表，将患者分为谵妄组（65例，男44例、女21例）和非谵妄组（451例，男284例、女167例）。采用单变量和多变量Logistic回归分析进行统计学处理。 结果在本项研究中，头颈部恶性肿瘤根治术后谵妄发生率为12.2%（65/516）。组间单因素分析结果显示，年龄（Z = 4.62，P<0.001）、吸烟史（χ² = 5.46，P = 0.019）、酗酒史（χ² = 5.74，P = 0.017）、手术时间（Z = 4.50，P<0.001）、气管切开（χ² = 14.26，P<0.001）、输血（χ² = 22.87，P<0.001）、游离皮瓣移植（χ² = 23.65，P<0.001）、重症监护时间（Z = 2.20，P = 0.028）、术后疼痛VAS值（Z = 3.64，P<0.001）、术后睡眠障碍（χ² = 21.19，P<0.001）、术后发热（χ² = 28.95，P<0.001）与术后谵妄相关。多因素Logistic回归分析结果显示，与谵妄相关的危险因素包括年龄（OR = 1.05，95%CI：1.02 ~ 1.08，P<0.001）、输血（OR = 2.64，95%CI：1.38 ~ 5.03，P = 0.003）、气管切开（OR = 4.02，95%CI：1.61 ~ 10.07，P = 0.003）、术后睡眠障碍（OR = 6.64，95%CI：3.43 ~ 12.84，P<0.001）、发热（OR = 3.28，95%CI：1.39 ~ 7.72，P = 0.007）和术后疼痛视觉模拟评分（VAS）值（OR = 1.42，95%CI：1.17 ~ 1.71，P<0.001）。 结论本研究确定了年龄、是否输血、气管切开、术后睡眠障碍、发热及术后疼痛是头颈部恶性肿瘤根治术后患谵妄的独立危险因素，可采取一定措施，同时提高围手术期的疼痛控制可能有助于预防谵妄的发生。     

妊娠期口腔颌面部多间隙感染的回顾分析

目的：总结分析妊娠期多间隙感染的临床特点和治疗方法，探索预防手段。方法：通过回顾分析2006年12月-2011年7月收治的15例妊娠期口腔颌面颈部多间隙感染患者的临床资料．对妊娠期口腔颌面部感染的病因、诊断和治疗等相关问题进行分析。结果：患者平均年龄28．6岁，孕周平均24．9周。对所有患者均采用口外切开排脓，每天换药，全身使用抗生素抗感染。患者平均换药天数为14d．平均使用抗生素时间为8d。治愈后分娩．其中1例早产，其余均足月产；7例人工分娩．8例自然分娩。新生儿各项指标均正常，新生儿指数平均为9．4，平均出生体重为3193go结论：妊娠期口腔颌面多间隙感染应早期诊断．早期对感染区切开引流。及时适当的处理．对妊娠结局和母婴健康无影响。     

口腔颌面部感染伴严重并发症23例临床分析

目的总结口腔颌面部感染伴严重并发症病例的经验教训，以提高其治愈率。方法收集口腔颌面部感染患者91例。伴有严重并发症23例，分析感染来源、药敏试验、临床表现、化验结果及治疗方法。结果本组23例伴有严重并发症，治愈22例，死亡1例。结论口腔颌面部感染伴严重并发症，病情进展快，病死率高，应及早积极治疗。根据药敏试验，选择敏感抗生素，联合、足量使用抗生素，加强全身支持治疗，纠正酸碱平衡紊乱，及早期处理病灶等综合治疗，才能有效控制病情，提高治愈率。     

口腔颌面部间隙感染疗效的影响因素分析

目的：探讨口腔颌面部间隙感染疗效的影响因素。方法：选取2009年7月～2015年7月110例口腔颌面部间隙感染病例为研究对象,运用抗生素等规范治疗,观察口腔颌面部间隙感染疗效的影响因素。结果：口腔颌面部间隙感染疗效的影响因素也是独立危险因素有病因、合并症、白细胞计数（≥20×109／L）、住院天数（≥14 d）、累及间隙数量（＞2个）、细菌培养、联合应用抗生素等（P＜0．05）;与患者性别、年龄、民族无关（P＞0．05）。结论：影响口腔颌面部间隙感染疗效的因素与疾病本身和医护无菌操作等有紧密关系。     

颌面部间隙感染275例临床分析

颌面部间隙感染 ,一般情况下 ,诊断和治疗并不困难 ,但如果处理不及时 ,常可引起严重并发症 ,甚至危及患者生命。本文就我科 1993.1.— 2 0 0 3.4 .间收住院的颌面部间隙感染病例 2 75例进行临床分析。临床资料1.一般资料　本组病例 2 75例 ,男 15 2例 ,女 12 3例 ,男∶女 1.2 3∶1。年龄最小 8个月 ,最大 84岁 ,平均 3 2岁。2 .感染部位及感染源2 75例颌面部间隙感染中 ,颌下间隙 86例 ,嚼肌间隙 5 8例 ,颊间隙 49例 ,眶下间隙 3 5例 ,口底间隙 16例 ,翼颌间隙 13例 ,咽旁间隙 8例 ,舌下间隙 4例 ,颞下间隙 3例 ,颏下间隙 3例。2 75例中牙…     

Surgical side infections of the tracheostomy – A retrospective cohort study of patients with head and neck cancer in intensive care

This study was conducted to reveal the relevant risk factors for surgical site infections (SSI) of the tracheostomy in ICU tracheostomy patients with oncologic history. Retrospectively, medical and ICU records of patients who received open tracheostomy in a uniform manner were investigated. Of 187 consecutive patients in total, patients with a peri/post-operative antibiotic prophylaxis (POABP) experienced significantly more Organ-Space SSI, whereas patients with a POABP developed less Superficial Incisional SSI and Deep Incisional SSI. Neck Dissection (p = 0.025), especially the more levels are included, and POABP (p = 0.005) have a significant impact on the occurrence of an SSI of the tracheostomy. Deep incisional SSI significantly prolonged a patient’s dependency on a ventilator (p = 0.045, M = 3.92, SD = 4.718). The difference between Superficial Incisional, Deep Incisional and Organ-Space SSI should be taken in consideration regarding risk evaluation and treatment. Furthermore, a gram-negative facultative anaerobic biofilm should be taken into consideration in treatment options and thus an escalation regarding antibiotic treatment as a POABP. For fulminant SSI of the tracheostomy the use of piperacillin/tazobactam or 3rd generation cephalosporines or carbapenems is recommendable.     

Socioeconomic determinants as risk factors for squamous cell carcinoma of the head and neck: a case-control study in Iran

Our aim was to assess the association between different components of sociodemographic status and the risk of developing squamous cell carcinoma (SCC) of the head and neck after we had adjusted for the influence of the known behavioural risk factors of smoking and drinking alcohol. We selected 146 patients with histopathologically-confirmed SCC of the head and neck, and matched them for age and sex with 266 healthy controls for this case-control study. Personal details, occupation, socioeconomic status, smoking, and alcohol consumption were recorded. The association of sociodemographic variables with oral cancer was evaluated both separately and with a composite socioeconomic index. Chi squared tests, adjusted odds ratios (OR), and 95% CI were computed using logistic regression to estimate the effect. There was a significant difference between the two groups in the composite socioeconomic index (p < 0.001). The group with “low” socioeconomic status had the highest risk of oral cancer (OR = 3.89, 95% CI 1.28 to 11.82). Better-educated people with higher incomes had a lower risk of SCC of the head and neck after we had controlled for behavioural risk factors. However, marital and employment status and place of residence were not significantly associated with risk. Our findings confirm that some socioeconomic determinants were associated with the development of oral cancer in this study group.     

The clinical features of severe multi-space infections of the head and neck in patients with diabetes mellitus compared to non-diabetic patients

We have recorded the clinical features of diabetic patients with multispace infections of the head and neck and compared them with those of non-diabetic patients. We retrospectively studied 191 patients who were treated for severe multispace infections of the head and neck, and compared the patients’ background, the aetiology of the infection, clinical variables, laboratory values (microbiology, and blood glucose concentration, white cell count (WCC), and percentage of neutrophils on admission) and treatment (the number of incisions, complications and duration of hospital stay). Statistical analyses of the differences between groups were made with Student's t test, the chi square test, and analysis of variance, as appropriate. Diabetic patients had more spaces involved concurrently (P = 0.02), required more incisions for drainage (P = 0.002), had longer hospital stays (P < 0.0001), and developed more complications (P = 0.02). Two diabetic patients died. We conclude that diabetic patients are more likely to develop complications and the complications are more likely to be severe than those in non-diabetic patients.     

Evolution assessment of head and neck infections in diabetic patients – A case control study

This research aimed to assess the occurrence and progression of head and neck infections in diabetic compared to non-diabetic patients.A retrospective study was carried out over a period of 10 years in 899 patients with head and neck infections. The patients who met the inclusion criteria were divided into cases and controls according to the presence/absence of diabetes.Seventy-three patients (8%, 95% CI [6.45%–10.12%]) were included in the case group and 826 (92%, 95% CI [89.87%–93.55%]) were assigned to the control group. The extension of the infection proved to be significantly (p < 0.001) higher in diabetic patients compared to non-diabetic patients. The difference between the two groups was statistically significant (Mann–Whitney U statistics = 18205.500, p < 1.56·10⁻⁸). A more than 10 year history of diabetes was statistically related to a wider extent of head and neck infections (p < 0.001).Diabetes proved to be associated with large necrotic areas and the spread of head and neck infections to more than two cavities.     

重度颌面颈部间隙感染的治疗--32例患者回顾性分析

目的：回顾总结重症颌面部间隙感染的治疗经验。方法：分析32例重症颌面颈部间隙感染患者的基本信息、治疗过程及转归,总结治疗经验。结果：2007-01～2013-01收治32位患者,病例数逐年增加,平均年龄57．71岁。11例（34．37％）患者出现呼吸道危象;19例（59．3％）伴发全身系统性疾病。8例患者转入胸外科及呼吸科,1例患者死亡,23例好转或治愈。脓送检率96．87％,检出率37．50％。培养结果以链球菌为主,其它可见葡萄球菌、铜绿假单胞菌、粪肠球菌、产黑素普雷沃菌、干燥奈瑟球菌、热带假丝酵母菌。结论：重症间隙感染患者近年明显增加。建议治疗措施：①保证呼吸道通畅及生命安全;②尽早手术切开引流,去除病灶;③降糖、降压、降温、镇痛、营养支持补液等多学科协同治疗;④全身抗感染治疗。     

种植义齿生物学并发症危险因素的回顾性分析

目的 ：分析引起种植固定义齿修复后生物学并发症的危险因素。方法 ：对2012年3月—2016年3月植入的725颗种植体随访5～9年,分别于修复完成3个月～1年、2～3年、4～5年、6～7年、8～9年测量种植体周黏膜指数（implant mucosal index, IMI）和种植体边缘骨丧失（implant marginal bone loss, MBL）,确定种植体周黏膜炎和种植体周炎的数量,统计种植修复后种植体周黏膜炎和种植体周炎发生率及其危险因素。采用SPSS 28.0软件包对数据进行统计学分析。结果：种植体5年存留率为98.7%。种植修复后8～9年的种植体周黏膜炎和种植体周炎发生率分别为37.5%和8.3%。吸烟、牙周炎、小直径种植体、非光滑颈部种植体、前牙区种植位点、种植体颈部骨增量等因素引起较高的种植体生物学并发症（P<0.05）。结论：种植义齿修复后生物学并发症的危险因素有吸烟、牙周炎、种植体直径、种植体颈部形态、种植位点、种植体颈部骨增量等。     

238例头颈肿瘤患者重建术后谵妄危险因素分析

目的 探讨头颈肿瘤患者重建术后谵妄发病的相关危险因素。方法 选择2018年10月—2019年10月于上海交通大学医学院附属第九人民医院接受头颈肿瘤术后重建患者238例,其中男160例,女78例;年龄16~85岁,平均（56.52±15.31）岁。依据《谵妄评估量表》结果,将患者分为谵妄组和非谵妄组,采用SPSS 17.0软件包分析患者术后谵妄的发病率和相关危险因素。结果 头颈肿瘤重建术后谵妄发病率为10.1%（24/238）。组间单因素分析发现,高龄、高血压、既往谵妄、术前睡眠紊乱、术后睡眠紊乱、术中输血、术后疼痛差异有统计学意义（P<0.05）;多因素Logistic回归分析发现,高龄（OR=1.090）、术后睡眠紊乱（OR=15.248）、术中输血（OR=1.003）、术后疼痛（OR=1.398）是患者术后发生谵妄的独立危险因素。结论 头颈肿瘤重建术后高龄、术中输血、术后睡眠紊乱和术后疼痛是谵妄发病的高危因素,应采取一定的预防措施,减少术后谵妄的发生。     

ASA grade and disease-free mortality in head and neck cancer patients: A prospective study

Complex surgery with curative intent as part of the care of patients with head and neck cancer, who also have serious coexisting conditions is sometimes viewed critically as being unduly, optimistic. We have used American Society of Anesthesiologists’ (ASA) grading by a single anaesthetist prospectively as a baseline to investigate a possible link between coexisiting conditions and disease-free survival in 114 patients with head and neck cancer patients treated by the same anaesthetist and surgical team, and found that the ASA grade is not a reliable predictor of disease-free survival. There was no significant association between ASA grade and overall mortality, but there was a significant association between ASA grade and mortality associated with metastatic disease. However, the test for trend was not significant, which suggested that deaths from metastatic disease did not increase in line with ASA grading. All patients in ASA grades II and III were alive 2 years after their initial operation and the risk of mortality after 2 years may increase by up to 10%.