口腔颌面部间隙感染的血常规和细菌学分析
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摘要
目的研究颌面部间隙感染的临床特点,探讨血常规、细菌培养对于颌面部间隙感染的诊断和治疗的意义。方法对2011年6月-2015年7月在我院颌面外科住院治疗的121例口腔颌面部间隙感染患者的住院病历进行回顾性研究,提取每个患者的年龄、性别、感染原因、感染部位、合并系统性疾病、血常规、菌培养结果等数据,并进行统计学分析。结果研究结果发现:病因学方面,成人多为牙源性感染,儿童多为牙源性或腺源性感染;感染最常累及的间隙为颌下间隙和颊间隙,分别有19.75%和18.50%的颌面部间隙感染患者合并有颌下间隙和颊间隙感染;菌培养结果显示最常见的病源菌为链球菌和葡萄球菌,分别占50%和27%;口腔颌面部间隙感染时白细胞增高,白细胞数目与感染的严重程度以及患者的住院天数之间的相关性存在统计学差异,白细胞计数低于13×10-9的患者感染程度轻,住院天数少;白细胞数目与患者是否患有糖尿病之间相关性无统计学差异。早期经验性用药结合菌培养结果的针对性用药获得了良好的临床治疗效果。结论监测血常规可以提示感染的严重程度、治疗效果。早期足量应用针对G+球菌、G-杆菌的广谱抗生素,并将其与抗厌氧菌的硝基咪唑类共同作为经验用药,再根据菌培养结果选用针对性药物,有助于增强抗菌效果,同时减少耐药菌株的产生。
Objective To study the clinical features of oral and maxillofacial space infection and discuss the significance of blood routine test and bacterial culture results in the diagnosis and treatment of maxillofacial space infection. Methods A total of 121 in patients with oral and maxillofacial space infection in our hospital from Jun 2011 to July 2015 were collected to make the retrospective studies, and the data of age, gender, cause of infection, site of infection, combined systemic disease, blood routine and bacterial culture of each patient were extracted and statistically analyzed. Results The results showed that : in terms of etiology,most adults were odontogenic infections, and most of the children were odontogenic or glandular infections;Submandibular space and buccal space were the most frequently involved spaces, and 19.75% and 18.50% of the patients with maxillofacial space infection had submandibular space and buccal space infection respectively;The results of bacterial culture showed that the most common pathogenic bacteria were streptococcus and staphylococcus, accounting for 50 % and 27 % separately.;The number of leukocytes increased,the correlation between the number of white blood cells and the severity of infection and the length of hospital stay was statistically different, patients with white blood cell count less than13×10-9 had less infection and fewer hospitalized days;the correlation between the number of white blood cells and whether the patient had diabetes or not was not statistically different..Early empirical use combined with the targeted drug use after obtaining the bacterial culture results has achieved a good clinical treatment effect.Conclusion Blood routine value can indicate the severity of infection, effect of treatment.An empirical treatment regimen is the early and sufficient use of broad-spectrum antibiotics against G+cocci, G-bacilli and nitroimidazoles against anaerobic bacteria, the dosing regimen is then adjusted after obtaining the bacterial culture results.This is helpful to enhance the antibacterial effect and reduce the occurrence of drug-resistant strains at the same time.
Objective To study the clinical features of oral and maxillofacial space infection and discuss the significance of blood routine test and bacterial culture results in the diagnosis and treatment of maxillofacial space infection. Methods A total of 121 in patients with oral and maxillofacial space infection in our hospital from Jun 2011 to July 2015 were collected to make the retrospective studies, and the data of age, gender, cause of infection, site of infection, combined systemic disease, blood routine and bacterial culture of each patient were extracted and statistically analyzed. Results The results showed that : in terms of etiology,most adults were odontogenic infections, and most of the children were odontogenic or glandular infections;Submandibular space and buccal space were the most frequently involved spaces, and 19.75% and 18.50% of the patients with maxillofacial space infection had submandibular space and buccal space infection respectively;The results of bacterial culture showed that the most common pathogenic bacteria were streptococcus and staphylococcus, accounting for 50 % and 27 % separately.;The number of leukocytes increased,the correlation between the number of white blood cells and the severity of infection and the length of hospital stay was statistically different, patients with white blood cell count less than13×10-9 had less infection and fewer hospitalized days;the correlation between the number of white blood cells and whether the patient had diabetes or not was not statistically different..Early empirical use combined with the targeted drug use after obtaining the bacterial culture results has achieved a good clinical treatment effect.Conclusion Blood routine value can indicate the severity of infection, effect of treatment.An empirical treatment regimen is the early and sufficient use of broad-spectrum antibiotics against G+cocci, G-bacilli and nitroimidazoles against anaerobic bacteria, the dosing regimen is then adjusted after obtaining the bacterial culture results.This is helpful to enhance the antibacterial effect and reduce the occurrence of drug-resistant strains at the same time.
引文
1 张志愿,俞光岩.口腔颌面外科学.第7版.北京:人民卫生出版社,2014. 177-200.
2 Smith JL, HSU JM, Chang J. Predicting deep neck space abscess using computed tomography. Am J Otolaryngol, 2006,27(4):244-247.
3 郑先雨,程继光.口腔颌面部间隙感染治疗效果的回顾性分析.安徽医药,2015,19(10):1966-1968.
4 杜传亮,李立英. 600例颌面部间隙感染临床分析.口腔颌面部外科杂志,2002,12(3):263-264.
5 Zhang C,Tang Y,Zheng M,et al. Maxillofacial space infection experience in West China:a retrospective study of 212 cases.International Journal of Infectious Diseases, 2010, 14(5):e414-e417.
6 Uluibau IC,Jaunay T,Goss AN. Severe odontongenic infections.Australian Dental Journal,2005,50(s2):S74-S81.
7 Huang Tung-Tsun, Liu Tien-Chen, Chen Peir-Rong, et al.Deep neck infection:Analysis of 185 cases. Head&Neck,2004,26(10):854-860.
8 Sato FR, Hajala FA, Filho Freire FW, et al. Eight-year retrospective study of odontogenic origin infections in a postgrauation program on oral and maxillofacial surgery. Journal of Oral and Maxillofacial Surgery,2009,67(5):1092-1097.
9 Flynn TR, Shanti RM, Levi MH, et al. Severe odontogenic infections, part 1:prospective report. Journal of Oral&Maxillofacial Surgery,2006,64(7):1093-1103.
10 丛丙峰,丁明超,等. 144例颌面部间隙感染患者的流行病学分析.实用口腔医学杂志,2016,32(2):212-215.
11 Rasteniene R,Puriene A,Aleksejuniene J,et al. Odontogenic maxillofacial infections:A ten-year retrospective analysis.Surgical Infections,2015,16(3):305-312.
12 曾晓燕,周维,张波.口腔颌面部间隙感染的临床分析.中华医院感染学杂志,2015,25(2):421-423.
2 Smith JL, HSU JM, Chang J. Predicting deep neck space abscess using computed tomography. Am J Otolaryngol, 2006,27(4):244-247.
3 郑先雨,程继光.口腔颌面部间隙感染治疗效果的回顾性分析.安徽医药,2015,19(10):1966-1968.
4 杜传亮,李立英. 600例颌面部间隙感染临床分析.口腔颌面部外科杂志,2002,12(3):263-264.
5 Zhang C,Tang Y,Zheng M,et al. Maxillofacial space infection experience in West China:a retrospective study of 212 cases.International Journal of Infectious Diseases, 2010, 14(5):e414-e417.
6 Uluibau IC,Jaunay T,Goss AN. Severe odontongenic infections.Australian Dental Journal,2005,50(s2):S74-S81.
7 Huang Tung-Tsun, Liu Tien-Chen, Chen Peir-Rong, et al.Deep neck infection:Analysis of 185 cases. Head&Neck,2004,26(10):854-860.
8 Sato FR, Hajala FA, Filho Freire FW, et al. Eight-year retrospective study of odontogenic origin infections in a postgrauation program on oral and maxillofacial surgery. Journal of Oral and Maxillofacial Surgery,2009,67(5):1092-1097.
9 Flynn TR, Shanti RM, Levi MH, et al. Severe odontogenic infections, part 1:prospective report. Journal of Oral&Maxillofacial Surgery,2006,64(7):1093-1103.
10 丛丙峰,丁明超,等. 144例颌面部间隙感染患者的流行病学分析.实用口腔医学杂志,2016,32(2):212-215.
11 Rasteniene R,Puriene A,Aleksejuniene J,et al. Odontogenic maxillofacial infections:A ten-year retrospective analysis.Surgical Infections,2015,16(3):305-312.
12 曾晓燕,周维,张波.口腔颌面部间隙感染的临床分析.中华医院感染学杂志,2015,25(2):421-423.