利用持续灌洗技术治疗颌面部多间隙严重感染的临床经验总结
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摘要
目的研究持续灌洗技术治疗颌面部多间隙严重感染的临床疗效。方法收集2017年1月至2018年10月,解放军总医院第四医学中心烧伤整形科颌面部多间隙严重感染患者18例。所有患者行颌面部多间隙充分切开引流,放置灌洗装置,每天根据病情需要,足量0. 9%氯化钠溶液冲洗,同时配合全身抗感染、营养支持、补液等对症治疗。结合临床观察研究的要求,全面评价患者全身情况和局部情况,包括抽血化验检测、影像学检查、细菌培养等,重点观察指标包括白细胞计数、中性粒细胞百分比、血红蛋白、血糖、白蛋白等。记录患者治疗期间颌面部疼痛及肿胀程度。结果18例患者经过持续灌洗治疗,颌面部肿胀及疼痛明显减轻。治疗前白细胞计数平均值为8. 72×109/L,术后第3天白细胞计数平均值5. 52×109/L;术前白蛋白平均值为33. 65 g/L;术后平均值为38. 25 g/L。检出率较高的细菌为金黄色葡萄球菌、肺炎克雷伯杆菌、铜绿假单细胞菌。CT扫描显示治疗后感染腔隙缩小,肿胀减轻。结论通过持续灌洗技术,不断的将坏死组织及分泌物稀释排出体外,减少毒素及细菌入血,可短期内控制病情,缩短住院时间,节省住院费用,减轻医务人员的负担,是治疗颌面部多间隙严重感染的新方法。
Objective To research the clinical efficacy of continuous lavage technology in the treatment of severe oral and maxillofacial multi-space infection.Methods From January 2017 to October 2018,18 cases of severe maxillofacial multi-space infection treated by Department of Burns and Plastic Surgery,Fourth Medical Center of People' s Liberation Army General Hospital were collected.All abscess cavity of oral and maxillofacial were sufficiently incised and drained and placed irrigating device,according to the needs of the disease flushed with sufficient amount of saline every day,at the same time,auxiliary treatments such as using anti-infection,nutrition support and suppling rehydration were provided.Combined the requirements of clinical observation and research,evaluating comprehensively the overall and local conditions of patients,including blood test,imaging examination,bacterial culture,etc.The key observation indicators included the total number of white blood cells,percentage of neutrophils,hemoglobin,blood sugar,albumin and so on.Recorded the degree of pain and swelling in maxillofacial region during treatment.Results The swelling and pain of the maxillofacial region of 18 patients disappeared completely,the average number of white blood cells before treatment was 8.72×10~9/L,the average number of white blood cells on the 3rd day after operation was 5.52×10~9/L,the average number of albumin before operation was 33.65 g/L,and the average number of albumin after operation was 38.25 g/L.The bacteria with higher detection rate were Staphylococcus aureus,Klebsiella pneumoniae and Pseudomonas aeruginosa.CT scan showed that the infection space was reduced and the swelling was alleviated after treatment.Conclusions Through continuous lavage technology,the necrotic tissues and secretionsis could be diluted and discharged from body continuously,reducing toxin and bacteria in to blood,which can control the disease in a short time.The continuous lavage technology is a new treatment for severe maxillofacial multi-space infection,which can shorten hospitalization time,save hospitalization expenses and lighten the burden of medical staff.
Objective To research the clinical efficacy of continuous lavage technology in the treatment of severe oral and maxillofacial multi-space infection.Methods From January 2017 to October 2018,18 cases of severe maxillofacial multi-space infection treated by Department of Burns and Plastic Surgery,Fourth Medical Center of People' s Liberation Army General Hospital were collected.All abscess cavity of oral and maxillofacial were sufficiently incised and drained and placed irrigating device,according to the needs of the disease flushed with sufficient amount of saline every day,at the same time,auxiliary treatments such as using anti-infection,nutrition support and suppling rehydration were provided.Combined the requirements of clinical observation and research,evaluating comprehensively the overall and local conditions of patients,including blood test,imaging examination,bacterial culture,etc.The key observation indicators included the total number of white blood cells,percentage of neutrophils,hemoglobin,blood sugar,albumin and so on.Recorded the degree of pain and swelling in maxillofacial region during treatment.Results The swelling and pain of the maxillofacial region of 18 patients disappeared completely,the average number of white blood cells before treatment was 8.72×10~9/L,the average number of white blood cells on the 3rd day after operation was 5.52×10~9/L,the average number of albumin before operation was 33.65 g/L,and the average number of albumin after operation was 38.25 g/L.The bacteria with higher detection rate were Staphylococcus aureus,Klebsiella pneumoniae and Pseudomonas aeruginosa.CT scan showed that the infection space was reduced and the swelling was alleviated after treatment.Conclusions Through continuous lavage technology,the necrotic tissues and secretionsis could be diluted and discharged from body continuously,reducing toxin and bacteria in to blood,which can control the disease in a short time.The continuous lavage technology is a new treatment for severe maxillofacial multi-space infection,which can shorten hospitalization time,save hospitalization expenses and lighten the burden of medical staff.
引文
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[8]王启晋,欧洪波.颌面部间隙感染的诊治研究进展[J].中国美容医学,2017,26(12):143-145.
[9]李丹,刘堃.负压封闭引流技术研究进展[J].中国医学工程,2011,19(5):171-172.
[2]章功杰,陈松军,郑珉,等.持续负压引流术治疗严重颌面颈部间隙感染的探讨[J].华西口腔医学杂志,2015,33(4):393-396.
[3]郭威孝,张凯,牛强,等.105例口腔颌面部间隙感染手术治疗回顾性分析[J].临床口腔医学杂志,2018,34(3):150-152.
[4]Babu VR,Ikkurthi S,Perisetty DK,et al.A Prospective Comparison of Computed Tomography and Magnetic Resonance Imaging as a Diagnostic tool for Maxillofacial Space Infections[J].J Int Soc Prev Community Dent,2018,8(4):343-348.
[5]王海云,周龙女,朱虹.ICU中重症口腔颌面部间隙感染89例病原学及耐药性分析[J].中国口腔颌面外科杂志,2017,16(6):538-542.
[6]Kaposvári I,K9rm9czi K,Horváth F,et al.Incidence and casecontrol study of delayed-onset infection after lower third molar surgery[J].Orv Hetil,2018,159(31):1278-1283.
[7]梅小妹.成年人口腔颌面部间隙感染50例临床分析[J].当代医学,2012,18(1):56-57.
[8]王启晋,欧洪波.颌面部间隙感染的诊治研究进展[J].中国美容医学,2017,26(12):143-145.
[9]李丹,刘堃.负压封闭引流技术研究进展[J].中国医学工程,2011,19(5):171-172.