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題 名 | Management of Descending Necrotizing Mediastinitis=向下感染的壞死性縱膈腔炎 |
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作 者 | 傅玉良; 范徽智; 許瀚水; 吳玉琮; 黃敏雄; 王良順; | 書刊名 | 中華醫學雜誌 |
卷 期 | 61:9 1998.09[民87.09] |
頁 次 | 頁513-519 |
分類號 | 416.226 |
關鍵詞 | 向下感染的壞死性縱膈腔炎; 膿胸; 食道穿孔; Descending necrotizing mediastinitis; Empyema; Esophageal perforation; |
語 文 | 英文(English) |
中文摘要 | 背景 向下感染的壞死性縱膈腔炎相當罕見,如果沒有適當及迅速的治療,死亡 率相當高,治療常因對此病的疏忽而被延誤。 方法 從1991年12月到1995年10月,我們陸續治療了8位急性向下感染的壞死性縱膈腔 炎患者。其中3位女性5位男性,平均年齡為45.8歲,年齡從22歲到71歲。感染來源: 有6位來自食道穿孔,1位來自頸部刺傷,另1位來自向下感染性的扁桃腺炎。我們描述病 人的臨床病徵,使用胸部X光、超音波及胸部和頸部的電腦斷層,來判斷是否需要外科引流 及擴創。引流的液體及擴創的組織均送培養,再根據培養結果調整合適的抗生素。有6位患 者接受了積極的外科引流及擴創,同時合用敏感的抗生素及機器呼吸和營養支持。有2位患 者只願意接受傳統的導管引流及支持性治療。 結果 6位接受多次適當和積極開胸擴創及引流的患者,最後均痊癒。另外2位拒絕接受擴 創及引流治燎的患者,分別於住院的第18及20天死於敗血症。經培養出的菌群包括: Klebsiella oxytoca、Staphviococcus、Trichosporum以及其它在口腔中常見的菌群。 結論 早期診斷是治療急性向下感染的壞死性縱膈腔炎的關鍵。適當的引流、擴創、施予敏 感的抗生素以及足夠的營養和呼吸支持,均可達到良好的治療成績。 |
英文摘要 | Background. Descending necrotizing mediastinitis (DNM) is uncommon, and may be lethal if not treated adequately and promptly. Delayed diagnosis of the disease is sometimes encountered in clinical practice. Methods. Eight consecutive patients with acute DNM were identified between 1991 and 1995, including five men and three women. The mean age was 45.8 years (range, 22-71 years). The infectious sources consisted of six esophageal perforations, one cervical cutting injury and one tonsillitis. The clinical presentations were evaluated. Diagnostic procedures including chest radiograph, sonogram and computerized tomography scans of the chest and neck were examined. Diagnosis and treatment, including culture results from drained fluids and debrided tissues, and antibiotic and supportive therapies were reviewed. Results. Six patients who underwent aggressive surgical treatment recovered well. Two patients who received supportive treatment died of sepsis alone. The cultured bacteria included: Klebsiella oxytoca, Staphylococcus aureus, Trichosporum and other mixed oral cavity flora. Conclusions. Early diagnosis and adequate antibiotic and support therapies are essential to achieve good patient outcomes in acute descending mediastinitis. Adequate drainage and debridement, appropriate antibiotic therapy, and sufficient nutritional and respiratory cnnnnrt are the main treatment elements. |
本系統中英文摘要資訊取自各篇刊載內容。