59例口腔颌面部多间隙感染继发下行坏死性纵隔炎的回顾性分析

目的通过分析口腔颌面部多间隙感染继发下行坏死性纵隔炎(descending necrotizing mediastinitis,DNM)患者的临床特点,为该病的防治提供依据。方法收集2010年3月~2020年3月新疆医科大学附属口腔医院颌面肿瘤外科收治的59例诊断为DNM患者的病例资料进行回顾性分析,所有患者通过胸部增强CT确诊,并转入重症监护病房(intensive care unit,ICU)治疗。对患者临床数据进行统计分析。结果DNMⅠ型患者21例(35.6%),DNMⅡA型患者19例(32.2%),DNMⅡB型患者19例(32.2%)。所有DNM患者均行急诊手术,Ⅰ型及ⅡA型患者经前纵隔剑突下切开引流配合胸腔引流;ⅡB型患者开胸纵隔彻底清创,术后引流;59例DNM患者的脓液全部送细菌培养,其中19例培养为阳性;全身抗炎治疗。死亡患者5例(8.5%),生存患者54例(91.5%)。与生存组相比,死亡组中年龄≥65岁、有糖尿病患者、入院到转入ICU时间间隔≥6 d、APACHEⅡ评分≥20、ICU治疗时间≥10 d、感染性休克患者占比高,差异有统计学意义(P<0.05)。结论及时转入ICU、配合早期手术、积极治疗全身系统性疾病和全身抗菌治疗是降低DNM死亡率的关键。

Retrospective analysis of 59 patients with descending necrotizing mediastinitis from oral and maxillofacial space infection

Objective A retrospective analysis aimed to identify the clinical features of patients with descending necrotizing mediastinitis(DNM) to improve the effects of treatment and prognosis.Methods The clinical data of 59 patients with DNM who were treated in the Department of Oncology of Oral and Maxillofacial Surgery of the Affiliated Stomatology Hospital of Xinjiang Medical University and transferred to the intensive care unit(ICU) were retrospectively analyzed from March 2010 to March 2020.Statistical analysis was performed to identify the risk factors that were associated with mortality.Results A total of 59 patients were identified:21 cases of DNM type Ⅰ(35.6%),19 cases of DNM type Ⅱ A(32.2%),and 19 cases of DNM type Ⅱ B(32.2%).All patients with DNM received emergency surgery.Patients with type Ⅰ and Ⅱ A underwent anterior mediastinal xiphoid incision and drainage combined with thoracic drainage.The thoracic mediastinum was completely debrided,and postoperative drainage was performed in type Ⅱ B patients.Pus samples from all 59 DNM patients were cultured for bacteria,and 19 of them were positive.Systemic antiinflammatory therapy was administered.Five patients died(8.5%),and 54 patients survived(91.5%).Compared with the survival group,the mortality group had a higher proportion of patients aged≥ 65 years,with diabetes,with an interval from admission to ICU≥ 6 days,with an APACHE Ⅱ score≥ 20 days,with a duration of IC.U treatment≥ 10 days,and with septic shock,with statistically significant differences(P <0.05).Conclusions Timely transfer to the intensive care unit for treatment combined with early active surgery and timely treatment of systemic diseases and systemic antimicrobial therapy is the key to reducing DNM mortality.