中国口腔颌面外科杂志

中国口腔颌面外科杂志 ›› 2024, Vol. 22 ›› Issue (2): 153-157.doi: 10.19438/j.cjoms.2024.02.007

• 论著 • 上一篇    下一篇

负压封闭引流在颌面颈部间隙感染致下行性坏死性纵隔炎治疗中的应用效果评价

赵冉冉1, 李晨曦1,2,*, 热孜万古丽·亚森1, 龚忠诚1,2,*   

  1. 1.新疆医科大学第一附属医院（附属口腔医院）口腔颌面肿瘤外科,新疆 乌鲁木齐 830054;
    2.新疆维吾尔自治区口腔医学研究所,新疆 乌鲁木齐 830054
  • 收稿日期:2023-08-25 修回日期:2023-10-10 出版日期:2024-02-20 发布日期:2024-03-27
  • 通讯作者: 龚忠诚,E-mail: gump0904@aliyun.com;李晨曦,E-mail: lichenximed@163.com。*共同通信作者
  • 作者简介:赵冉冉（1998-）,女,硕士研究生,E-mail: 2970934927@qq.com
  • 基金资助:
    新疆维吾尔自治区天山创新团队项目（2021D14001）; 新疆维吾尔自治区科研创新项目（XJ2023G174）

Clinical application of vacuum sealing drainage in the treatment of descending necrotizing mediastinitis caused by maxillofacial and neck space infection

ZHAO Ran-ran1, LI Chen-xi1,2,*, REZIWANGULI Yasen1, GONG Zhong-cheng1,2,*   

  1. 1. Oncological Department of Oral and Maxillofacial Surgery, First Affiliated Hospital of Xinjiang Medical University, School / Hospital of Stomatology Xinjiang Medical University. Urumqi 830054;
    2. Stomatological Research Institute of Xinjiang Uygur Autonomous Region. Urumqi 830054, Xinjiang Uygur Autonomous Region, China
  • Received:2023-08-25 Revised:2023-10-10 Online:2024-02-20 Published:2024-03-27

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摘要： 目的: 探讨负压封闭引流（vacuum sealing drainage,VSD）在颌面颈部间隙感染致下行性坏死性纵隔炎（descending necrotizing mediastinitis, DNM ）中的临床应用效果。方法: 回顾2014年7月—2023年7月就诊于新疆医科大学附属口腔医院采用负压封闭引流术治疗的53例DNM患者的临床资料,对治疗效果进行总结分析。采用SPSS 26.0软件包对数据进行统计分析。结果: 53例患者中,3例放弃治疗,1例死亡,其余患者均治愈出院。平均住院天数（25.3±13.75） d,VSD平均放置时间（16.15±8.22） d, ICU平均监护时间（12.02±11.56） d,平均更换VSD次数（1.57±1.32）次。患有糖尿病患者与血糖正常患者的住院天数、ICU监护时间、VSD使用时长、抗生素使用天数、住院总费用,入院时中性粒细胞数与淋巴细胞数比值（N/L值）、白介素6（IL-6）及D-二聚体（D-D）值均有显著差异。结论: 负压封闭引流术在颌面颈部间隙感染致下行性纵隔炎的治疗中创伤小,能促进炎症吸收,减轻患者病程中换药的痛苦,对于感染至前下纵隔及全纵隔的病例,联合胸腔闭式引流或纵隔切开引流,效果肯定,具有一定的临床应用价值。

关键词: 负压封闭引流, 颌面颈部多间隙感染, 下行性坏死性纵隔炎, 糖尿病

Abstract: PURPOSE: To explore the clinical therapeutic effect of vacuum sealing drainage(VSD) on descending necrotizing mediastinitis(DNM) caused by maxillofacial and neck space infection. METHODS: The clinical data of 53 DNM patients treated with VSD in the First Affiliated Hospital of Xinjiang Medical University from July 2014 to July 2023 were reviewed, and the therapeutic effect was summarized and analyzed. SPSS 26.0 software package was used for data analysis. RESULTS: Of the 53 patients, 3 gave up treatment, 1 died, and the remaining were cured and discharged. Among the 53 patients, the average hospitalization time was (25.3±13.75) d, the average placement time of VSD was (16.15±8.22) d , the average monitoring time of ICU was (12.02±11.56) d, the average number of replacements of VSD was 1.57±1.32. There were significant differences between patients with diabetes and patients with normal blood glucose in length of hospital stay, ICU stay, VSD use, antibiotic use, total hospitalization cost, neutrophil to lymphocyte count ratio(N/L value), interleukin-6(IL-6) and D-dimer (D-D) value at admission. CONCLUSIONS: VSD has little surgical trauma in the treatment of DNM, promotes inflammatory absorption, and reduces the pain of dressing change during the course of the disease. For cases of infection to the anterior and lower diaphragm and total mediastinum, combined with closed thoracic drainage or mediastinial incision, the drainage effect is certain and has a distinct clinical application value.

Key words: Vacuum sealing drainage, Maxillofacial and cervical multiple space infection, Descending necrotizing mediastinitis, Diabetes

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