48例頜面部間隙感染的臨床分析
發(fā)布時間：2019-02-28 15:32
【摘要】：目的：分析頜面部間隙感染的病因、診斷及治療方法，為該病的診治提供參考。 方法：回顧性研究了自2011年1月至2013年12月在山西醫(yī)科大學第一醫(yī)院住院治療的48名診斷為頜面部間隙感染的患者臨床資料，均監(jiān)測血糖、行實驗室微生物學檢查、頜面部CT檢查，行感染部位切開引流，取膿液做細菌培養(yǎng)及藥敏試驗，這48例患者的膿液培養(yǎng)均為普通細菌培養(yǎng)，未行厭氧菌培養(yǎng)。出現(xiàn)肺部感染、胸腔積液的給予胸腔閉式引流、抗生素及全身支持治療。 結(jié)果：48例患者中牙源性感染29例（60.4%），由化膿性涎腺炎、化膿性淋巴結(jié)炎引起的腺源性感染14例（29.2%），損傷性感染3例（6.3%），，醫(yī)源性感染2例（4.1%）。多間隙感染多見，為24例；其次依次為頜下間隙、咬肌間隙、頰間隙、眶下間隙、咽旁間隙。膿液細菌培養(yǎng)結(jié)果為陽性的有35例，細菌培養(yǎng)結(jié)果為：草綠色鏈球菌14例，β溶血性鏈球菌8例，金黃色葡萄球菌8例，糞腸球菌2例，肺炎克雷伯氏菌2例，念珠菌1例。根據(jù)患者全身狀況，均在膿腫形成時行切開引流。根據(jù)是否合并糖尿病，比較糖尿病患者與非糖尿病患者的多間隙感染的發(fā)生率，采用統(tǒng)計學分析，兩者的發(fā)生率有差異，合并糖尿病的患者多間隙感染的發(fā)生率明顯高于未合并糖尿病的患者，而且住院天數(shù)明顯高于未合并糖尿病的患者。 結(jié)論： 1、牙源性感染為頜面部感染的首要病因，草綠色鏈球菌為主要致病菌。 2、本病治療關鍵在于及時的切開引流，適時去除病灶。在膿腫形成時及時行切開引流，可以有效的控制感染。而采用小切口負壓引流治療間隙感染，在取得同樣治療效果的同時，還能減少患者治愈后的瘢痕。 3、合并糖尿病患者的感染更容易累及多間隙，并且感染較難控制，住院天數(shù)較長。在治療感染時應注意血糖的控制。
[Abstract]:Objective: to analyze the etiology, diagnosis and treatment of maxillofacial space infection in order to provide reference for the diagnosis and treatment of this disease. Methods: the clinical data of 48 patients diagnosed as maxillofacial space infection in the first Hospital of Shanxi Medical University from January 2011 to December 2013 were retrospectively studied. Blood glucose was monitored and laboratory microbiological examination was performed. Maxillofacial CT examination, incision and drainage of infected sites, bacterial culture and drug sensitivity test were performed in 48 patients. All of the 48 patients had normal bacterial culture, but no anaerobes culture. Pulmonary infection, pleural effusion with closed thoracic drainage, antibiotics and systemic support treatment. Results: among the 48 patients, 29 (60.4%) were odontogenic infection, 14 (29.2%) were adenogenic infection caused by suppurative sialitis, 3 (6.3%) were traumatic infection, and 14 (29.2%) were adenogenic infection caused by suppurative sialitis and suppurative lymphadenitis. Iatrogenic infection occurred in 2 cases (4.1%). Multiple space infection was found in 24 cases, followed by submandibular space, masseter space, buccal space, suborbital space and parapharyngeal space. The results of bacterial culture in pus were positive in 35 cases. The results were as follows: 14 cases of Streptococcus viride, 8 cases of 尾-hemolytic streptococcus, 8 cases of Staphylococcus aureus, 2 cases of Enterococcus faecalis, 2 cases of Klebsiella pneumoniae and 1 case of Candida. According to the general condition of the patients, all the patients underwent incision and drainage at the time of formation of abscess. To compare the incidence of multi-interval infection between diabetic patients and non-diabetic patients according to whether or not they were complicated with diabetes, statistical analysis showed that there was a difference in the incidence rate between diabetic patients and non-diabetic patients. The incidence of multiple interval infection in patients with diabetes mellitus was significantly higher than that in patients without diabetes mellitus, and the length of hospitalization was significantly higher than that in patients without diabetes mellitus. Conclusion: 1 Odontogenic infection is the primary cause of maxillofacial infection, and Streptococcus viride is the main pathogen. 2, the key to the treatment of the disease is timely incision and drainage, timely removal of the focus. In the formation of abscess timely incision and drainage, can effectively control infection. The use of small incision negative pressure drainage in the treatment of interstitial infection, can achieve the same therapeutic effect, but also reduce the cured scar. 3. The infection in patients with diabetes mellitus was more likely to involve multiple spaces, and the infection was more difficult to control, and the length of hospital stay was longer. Attention should be paid to the control of blood sugar in the treatment of infection.
【學位授予單位】：山西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R782
本文編號：2431925
[Abstract]:Objective: to analyze the etiology, diagnosis and treatment of maxillofacial space infection in order to provide reference for the diagnosis and treatment of this disease. Methods: the clinical data of 48 patients diagnosed as maxillofacial space infection in the first Hospital of Shanxi Medical University from January 2011 to December 2013 were retrospectively studied. Blood glucose was monitored and laboratory microbiological examination was performed. Maxillofacial CT examination, incision and drainage of infected sites, bacterial culture and drug sensitivity test were performed in 48 patients. All of the 48 patients had normal bacterial culture, but no anaerobes culture. Pulmonary infection, pleural effusion with closed thoracic drainage, antibiotics and systemic support treatment. Results: among the 48 patients, 29 (60.4%) were odontogenic infection, 14 (29.2%) were adenogenic infection caused by suppurative sialitis, 3 (6.3%) were traumatic infection, and 14 (29.2%) were adenogenic infection caused by suppurative sialitis and suppurative lymphadenitis. Iatrogenic infection occurred in 2 cases (4.1%). Multiple space infection was found in 24 cases, followed by submandibular space, masseter space, buccal space, suborbital space and parapharyngeal space. The results of bacterial culture in pus were positive in 35 cases. The results were as follows: 14 cases of Streptococcus viride, 8 cases of 尾-hemolytic streptococcus, 8 cases of Staphylococcus aureus, 2 cases of Enterococcus faecalis, 2 cases of Klebsiella pneumoniae and 1 case of Candida. According to the general condition of the patients, all the patients underwent incision and drainage at the time of formation of abscess. To compare the incidence of multi-interval infection between diabetic patients and non-diabetic patients according to whether or not they were complicated with diabetes, statistical analysis showed that there was a difference in the incidence rate between diabetic patients and non-diabetic patients. The incidence of multiple interval infection in patients with diabetes mellitus was significantly higher than that in patients without diabetes mellitus, and the length of hospitalization was significantly higher than that in patients without diabetes mellitus. Conclusion: 1 Odontogenic infection is the primary cause of maxillofacial infection, and Streptococcus viride is the main pathogen. 2, the key to the treatment of the disease is timely incision and drainage, timely removal of the focus. In the formation of abscess timely incision and drainage, can effectively control infection. The use of small incision negative pressure drainage in the treatment of interstitial infection, can achieve the same therapeutic effect, but also reduce the cured scar. 3. The infection in patients with diabetes mellitus was more likely to involve multiple spaces, and the infection was more difficult to control, and the length of hospital stay was longer. Attention should be paid to the control of blood sugar in the treatment of infection.
【學位授予單位】：山西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R782
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本文編號：2431925
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