口腔疾病防治2024，Vol.32Issue(2)：123-130,8.DOI:10.12016/j.issn.2096-1456.2024.02.006
下行性坏死性纵隔炎:一项基于我国近10年已发表数据的临床分析
Descending necrotizing mediastinitis:a clinical analysis based on 10 years of published data in China
摘要
Abstract
Objective To investigate the clinical characteristics,diagnosis,treatment,and prognosis of descending necrotizing mediastinitis(DNM)to provide a reference for the early diagnosis and timely treatment of DNM.Methods Data on DNM in China was electronically retrieved from the core databases and comprehensively reviewed from June 2012 to June 2023.The infection,pathogenic microorganisms,main symptoms,comorbidities and treatment methods of DNM were analyzed.Results The data of a total of 781 DNM patients,with an average age of(52.97±5.64)years,were retrieved,including 554 males and 227 females.Odontogenic source,tonsillitis,pharyngeal abscess,sialoadenitis,upper respiratory tract infection,foreign body injury,or iatrogenic traumatic procedures are common causes.Among these,odontogenic infection is the most common source.Streptococcus sp.(n=217)and Staphylococcus sp.(n=82)were most isolated,followed by Klebsiella pneumoniae and Pseudomonas aeruginosa(equally n=59).A total of 69.4％(542/781)of DNM patients recruited in this study were discovered to have various comorbidities,and more than one-third of these patients(n=185)had diabetes.Of the broad antibiotics,carbapenem was most frequently used as treatment,and vancomycin was the most frequently coadministered.The mediastinal drainage approach varies widely,and the optimal regimen is still unknown.Seventy-two patients were treated with video-assisted thoracoscopic/mediastinoscopic surgical drainage,22 patients were treated with percutaneous catheter drainage,30 underwent the transcervical approach,and 40 underwent thoracotomy.A total of 617 patients who were selected underwent the appropriate combined operation for surgical drainage according to the specific location of the infected focus.The overall mortality rate of all 781 DNM pa-tients included was 11.2％.Conclusion The most effective diagnosis and treatment of DNM is a high degree of clini-cal vigilance followed by prompt and adequate drainage with intensive care,including hemodynamic monitoring,nutri-tional support,computer tomographic scanning repeated as necessary,and combined use of systemic antibiotics.关键词
牙源性感染/腺源性感染/口腔颌面部多间隙感染/颈部坏死性筋膜炎/下行性坏死性纵隔炎/回顾性分析/循证医学Key words
odontogenic infection/glandular infection/oral and maxillofacial multispace infection/cervical necrotizing fasciitis/descending necrotizing mediastinitis/retrospective analysis/evidence-based medicine分类
医药卫生引用本文复制引用
李晨曦,赵冉冉,孙清超,龚忠诚,刘慧,张维娜,丁明超..下行性坏死性纵隔炎:一项基于我国近10年已发表数据的临床分析[J].口腔疾病防治,2024,32(2):123-130,8.基金项目
国家自然科学基金项目(82360481) （82360481）
湖北省口腔颌面发育与再生重点实验室开放课题基金(2022kqhm008) （2022kqhm008）
新疆维吾尔自治区科研创新项目(XJ2023G174) （XJ2023G174）
省部共建中亚高发病成因与防治国家重点实验室开放课题(SKL-HIDCA-2020-SG3)This study was supported by the grants from National Natural Science Foundation of China(No.82360481) （SKL-HIDCA-2020-SG3）
Open Proj-ect of Hubei Province Key Laboratory of Oral and Maxillofacial Development and Regeneration(No.2022kqhm008) （No.2022kqhm008）
Xinjiang Postgraduate Scientific Research Innovation Project(No.XJ2023G174)and State Key Laboratory of Pathogene-sis,Prevention and Treatment of High Incidence Diseases in Central Asia Fund(No.SKL-HIDCA-2020-SG3). （No.XJ2023G174）
