眶蜂窝织炎63例分析

目的 探讨眶蜂窝织炎的致病原因、致病菌及并发症.方法 回顾性病例系列研究.回顾性分析西京医院自1960年至2008年收治的63例眶蜂窝织炎住院患者的临床资料,对其性别、年龄、致病途径、致病菌及并发症进行分析.结果 63例患者中,男性48例（76.2%）,女性15例（23.8%）;10岁以下年龄组患者较多（22例,34.9%）;单眼发病多见（61例,96.8%）;32例（50.8%）患者伴有明显眼球突出.致病途径以周围组织炎症蔓延最多见（47.6%）,其他包括血行感染（19.0%）、眼部外伤（15.9%）和眼部手术后并发感染（3.2%）.30例患者进行了细菌培养,仅18例（60.0%）细菌培养为阳性.致病菌有4类,以葡萄球菌属最为多见（14例,77.8%）,尤以金黄色葡萄球菌为主（8例,44.4%）,此外还有绿脓杆菌（11.1%）、甲型溶血性链球菌（5.6%）和中间型弗氏枸橼酸杆菌（5.6%）.本组有19例（30.1%）发生并发症,包括败血症（12.7%）、暴露性角膜炎（4.8%）、全眼球炎（4.8%）、化脓性脑膜炎（4.8%）和海绵窦栓塞性静脉炎（3.2%）等.结论 眶蜂窝织炎多见于10岁以下儿童患者,以单眼眼球突出为主要表现,致病途径以眶周组织结构感染蔓延为主.细菌培养阳性率较低,以金黄色葡萄球菌为主要致病菌.本病可发生严重并发症,宜早期积极给予广谱抗生素治疗,如脓肿形成应及时切开引流.

Analysis of sixty-three cases of orbital cellulitis

Objective To investigate the clinical characteristics, etiological factors and pathogenic bacterium of orbital cellulitis. Methods A retrospective clinical study was done on 63 orbital cellulitis patients receiving treatments in Xijing Hospital between 1960 to 2008, and their gender, age, pathogenic approach, pathogens and complications were analyzed. Results Of the 63 patients, 76.2% were males and 23.8% were females. The highest incidence occurred in the 0-10 year old group (34.9%). There were 96.8% of the patients suffered unilateral eye injures, 50.8% of the patients expressed obvious exophthalmos. The pathogenic approaches mainly involved the surrounding tissue infection (47.6%), others included blood stream infections (19.0%), ocular trauma (15.9%) and postoperative infection in the eye (3.2%). Thirty patients had bacterial cultures but only 18 cases (60.0%) showed positive results. There were 4 main pathogens. Staphylococcus was the main pathogen (77.8%), especially staphylococcus aureus (44.4%). In addition, there were pseudomonas (11.1%), A-hemolytic streptococcus (5.6%) and intermediate freund citrobacter (5.6%). Complications included sepsis (12.7%), exposure keratitis (4.8%), panophthalmitis (4.8%), purulent meningitis (4.8%) and cavernous sinus thrombophlebitis (3.2%), etc. Conclusion Orbital cellulitis mostly occurrs in child patients under 10 years of age. Exophthalmos is the primary feature. The main pathogenic approach involve surrounding tissue infection. The positive rate of bacterial cultures is relatively low,in which staphylococcus aureus is the chief pathogen, followed by A-hemolytic streptococcus,pseudomonas, etc. Orbital cellulitis may be accompanied with severe complications and a low rate of positive bacterial culture, therefore a broad-spectrum antibiotic therapy is needed during the early stage, and incision and drainage should be performed in a timely manner for abscess formation.