48例颌面部间隙感染的临床分析

发布时间：2019-02-28 15:32

【摘要】：目的：分析颌面部间隙感染的病因、诊断及治疗方法，为该病的诊治提供参考。方法：回顾性研究了自2011年1月至2013年12月在山西医科大学第一医院住院治疗的48名诊断为颌面部间隙感染的患者临床资料，均监测血糖、行实验室微生物学检查、颌面部CT检查，行感染部位切开引流，取脓液做细菌培养及药敏试验，这48例患者的脓液培养均为普通细菌培养，未行厌氧菌培养。出现肺部感染、胸腔积液的给予胸腔闭式引流、抗生素及全身支持治疗。结果：48例患者中牙源性感染29例（60.4%），由化脓性涎腺炎、化脓性淋巴结炎引起的腺源性感染14例（29.2%），损伤性感染3例（6.3%），，医源性感染2例（4.1%）。多间隙感染多见，为24例；其次依次为颌下间隙、咬肌间隙、颊间隙、眶下间隙、咽旁间隙。脓液细菌培养结果为阳性的有35例，细菌培养结果为：草绿色链球菌14例，β溶血性链球菌8例，金黄色葡萄球菌8例，粪肠球菌2例，肺炎克雷伯氏菌2例，念珠菌1例。根据患者全身状况，均在脓肿形成时行切开引流。根据是否合并糖尿病，比较糖尿病患者与非糖尿病患者的多间隙感染的发生率，采用统计学分析，两者的发生率有差异，合并糖尿病的患者多间隙感染的发生率明显高于未合并糖尿病的患者，而且住院天数明显高于未合并糖尿病的患者。结论： 1、牙源性感染为颌面部感染的首要病因，草绿色链球菌为主要致病菌。 2、本病治疗关键在于及时的切开引流，适时去除病灶。在脓肿形成时及时行切开引流，可以有效的控制感染。而采用小切口负压引流治疗间隙感染，在取得同样治疗效果的同时，还能减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间隙，并且感染较难控制，住院天数较长。在治疗感染时应注意血糖的控制。
[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.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R782

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