颈深部间隙脓肿临床危险因素分析

目的 探讨颈深部间隙脓肿可能增加手术治疗风险及增加药物治疗失败风险的临床危险因素.方法 回顾性分析2009年1月~2016年6月颈深部间隙脓肿患者111例,采用Logistic回归模型筛选危险因素.结果 所有患者均经药物治疗和(或)手术治疗痊愈.在α=0.05的水准,呼吸困难是增加手术治疗风险的临床危险因素(β=3.001,OR=20.099);脓肿最大直径>2.0 cm是增加手术治疗风险和药物治疗失败风险的临床危险因素(β=2.396,OR=10.979;β=4.618,OR=101.313).年龄、性别、白细胞计数、发热、糖尿病、颈部肿胀及多间隙感染不会增加手术治疗的风险.结论 对于存在呼吸困难及脓肿最大直径>2.0 cm的颈深部间隙脓肿患者应积极术前准备,尽早手术干预;而无呼吸困难及脓肿最大直径≤2.0 cm的患者,在经足量有效抗生素治疗及严密监护下,往往能避免手术切开引流.

Analysis of clinical risk factors of the deep space neck absces

OBJECTIVE To identify the clinical risk factors related to the increasing likelihood of surgical drainage and the medical therapy failure in deep space neck abscess. METHODS The clinical data of 111 consecutive patients from January 2009 to June 2016 with deep space neck abscess were reviewed retrospectively. Logistic regression analysis was used to study the clinical risk factors by stepwise forward regression. RESULTS All patients had successful resolution of their infections by medical therapy and(or) surgical drainage. At the level of α=0.05, dyspnea was the risk factor of increasing likelihood of surgical drainage (β=3.001, OR=20.099); the maximum dimension of abscess>2.0 cm was not only the risk factor of increasing likelihood of surgical drainage(β=2.396, OR=10.979), but also that of medical therapy failure(β =4.618, OR=101.313). Age, sex, white blood cell count at presentation, fever, diabetes, neck swelling, and multiple space abscess of neck did not increase the risk of surgical treatment (P>0.05, respectively). CONCLUSION Active preoperative preparation and surgical intervention should be used with those who have dyspnea and the maximum dimension of abscess >2.0 cm as soon as possible. However, those who without dyspnea and abscess size less than or equal to 2.0 cm may be recovered without incision and drainage of operation by only sufficient and effective intravenous antibiotics treatment under close guarded surveillance.