摘要
目的探讨非洲尼日尔地区颈深部脓肿患者的临床特征,总结本病的诊治方法。方法对在援非医疗队尼日尔尼亚美医院诊治的62例颈深部脓肿患者行抗炎治疗,53例脓肿切开引流、5例尚未切开引流即死亡、4例因淋巴结结核转内科门诊治疗。经济条件允许者静脉用抗菌药物,1～2周后改用口服药;条件不允许者静脉用抗菌药物3～5 d后改口服用药,出院门诊治疗。结果 (1)牙源性感染18例、颈部淋巴结化脓性感染14例、扁桃体周围脓肿10例、上呼吸道感染8例、化脓性扁桃体炎6例、颈淋巴结结核4例、食管异物感染2例。(2)实验室检查:25例脓培养均阳性:铜绿假单孢菌8例,变异性链球菌6例,金黄色葡萄球菌10例,大肠埃希菌1例。(3)影像学检查:6例B超检查提示有脓肿;2例行X线检查,其中1例提示梨状窝右侧有一球形阴影;1例食管吞钡摄片显示颈前脓肿有钡剂渗入,提示咽瘘;1例CT检查确诊颈前部大面积脓肿,并有气体,无纵隔脓肿。(4)62例随诊6个月～1年,痊愈49例、死亡8例、失访5例。结论颈深部脓肿的并发症常威胁生命,在医疗条件差的非洲及国内部分基层医院,应该重视本病的临床特征,一旦确诊,应尽早行脓肿切开引流,合理、足量、足疗程地应用抗生素。
Objective To explore the treatment approaches to deep neck abscess in Niger, Africa. Methods Anti - inflammatory treatment was conducted on 62 cases of neck deep abscess by us in the Niger Niamey hospital. Incision and drain- age was performed on 53 cases, 5 cases died before incision and drainage, and 4 cases of lymph node tuberculosis were referred to Internal Medicine Department. Intravenous antibiotics were administered for 1 ~ 2 weeks before switching to oral medication for those who could afford it. Otherwise, intravenous antibiotics were administered for 3 - 5 days before oral medication. Results Among the 62 eases of deep neck abscess, 18 were caused by odontogenic infection, 14 by pyogenic infection of cervical lymph nodes, 10 peritonsillar abscess, 8 upper respiratory tract infection, 6 suppurative tonsillitis , 4 tuberculosis in cervical lymph nodes, and 2 esophageal foreign body infection. Laboratory tests proved positive for 25 cases of pus culture, including 8 cases of Pseudomonas aernginosa, 6 variant Streptococcus, 10 Staphylococcus anreus, and 1 case of E. coli. Imaging examination re- sults showed 6 cases of abscess （ type B ultrasonography）, 1 case of spherical shadow by right of sinus piriformis and 1 case of barium infiltration into anterior cervical abscess indicating pharyngeal fistula （ X - ray）, 1 case of massive anterior cervical ab- scess with gas but no mediastinal abscess. Among the 62 cases followed up for 6 months to one year, 49 cases recovered, 8 died, and 5 were lost to follow - up. Conclusion Deep neck abscess often has life threatening complications. In Africa and some basic hospitals in China where medical conditions are poor, doctors should pay close attention to the clinical features of this disease. Once diagnosed with deep neck abscess, the patients should be performed with abscess incision and drainage as early as possible, and given appropriate and sufficient antibiotics.
出处
《中国全科医学》
CAS
CSCD
北大核心
2013年第14期1675-1676,共2页
Chinese General Practice
关键词
颈深部脓肿
切开引流
抗菌药
Neck deep abscess
Incision and drainage
Anti -bacterial agents
