牙源性下行性坏死性纵隔炎的治疗及护理

目的：总结牙源性感染累及前纵隔的下行性坏死性纵隔炎的护理经验。方法：14例下行性坏死性纵隔感染患者（年龄30，70岁．平均年龄45岁）．均为牙源性感染。其中，前上纵隔感染9例，整个前纵隔感染5例，所有患者均给予心理护理、呼吸道护理．同时加强营养支持．积极治疗及控制基础疾病；术后根据引流管位置，做好双套管冲洗及胸腔冲洗．确保引流通畅。结果：除1例患者早期因感染性休克死亡外，其余患者均痊愈，死亡率为8.3％，发生肺部感染6例．ARDS2例，肾功能不全1例。结论：下行性坏死性纵隔炎需根据感染的部位采取相应的治疗措施，严密观察病情变化。通畅的引流及科学的呼吸道护理．是控制病情发展和预防并发症发生的关键。

Surgical treatment and nursing of descending necrotizing anterior mediastinitis due to odontogenic infections

PURPOSE： To summarize the nursing experience of descending necrotizing mediastinitis （DNM）. METHODS： Retrospective study was performed in 14 patients with descending necrotizing anterior mediastinitis treated from June 2010 to December 2012. All DNM in this study originated from odontogenic infections. The infections went down from the cervical region to the upper anterior mediastinum in 9 patients, to the whole anterior mediastinum in 5 patients. All patients underwent mediastinal drainage, psychological care, respiratory tract management, strengthened nutritional support and control of the underlying disease. RESULTS： All patients were cured except for one dying from severe septic shock, the mortality was 8.3%. The postoperative complications included pneumonia in 6 cases, adult respiratory distress syndrome in 2 cases and renal insufficiency in 1 case. CONCLUSION： Appropriate therapeutic measures according to the site of infection, prompt surgical drainage and efficient respiratory care can significantly reduces complications caused by DNM.