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中华老年病研究电子杂志 ›› 2020, Vol. 07 ›› Issue (03) : 21 -25. doi: 10.3877/cma.j.issn.2095-8757.2020.03.005

所属专题: 文献

临床研究

老年颈部坏死性筋膜炎预后影响因素分析
余爵波1, 程泽星1,(), 庄远岭1, 郑海洲1   
  1. 1. 225001 扬州大学附属医院耳鼻咽喉科
  • 收稿日期:2020-02-02 出版日期:2020-08-28
  • 通信作者: 程泽星

Prognostic factors of cervical necrotizing fasciitis of neck in elderly patients

Juebo Yu1, Zexing Cheng1,(), Yuanling Zhuang1, Haizhou Zheng1   

  1. 1. Department of Otolaryngology, Affiliated Hospital of Yangzhou University, Yangzhou 225001, China
  • Received:2020-02-02 Published:2020-08-28
  • Corresponding author: Zexing Cheng
  • About author:
    Corresponding author: Cheng Zexing, Email:
引用本文:

余爵波, 程泽星, 庄远岭, 郑海洲. 老年颈部坏死性筋膜炎预后影响因素分析[J/OL]. 中华老年病研究电子杂志, 2020, 07(03): 21-25.

Juebo Yu, Zexing Cheng, Yuanling Zhuang, Haizhou Zheng. Prognostic factors of cervical necrotizing fasciitis of neck in elderly patients[J/OL]. Chinese Journal of Geriatrics Research(Electronic Edition), 2020, 07(03): 21-25.

目的

探讨影响老年颈部坏死性筋膜炎(cervical necrotizing fasciitis, CNF)预后的相关因素。

方法

对扬州大学附属医院2006年1月至2018年12月收治的35例老年CNF患者的完整资料进行分析,比较术后死亡患者和存活患者的临床资料,将单因素分析有统计学意义的指标代入多因素Logistic回归模型进行多因素分析。

结果

35例CNF患者术后3~10(6.8±1.3)d死亡9例(死亡组),存活26例(存活组)。单因素分析结果显示,两组患者病程、红细胞及白细胞计数、血糖水平、超敏C反应蛋白水平、血红蛋白水平、24 h内清创与否、24 h内是否出现休克、48 h内是否出现下行性胸膜炎、并发症种类、教育程度、是否出现耐药菌、家庭收入的差异有统计学意义(P<0.05或0.01)。进一步Logistic回归分析显示,单因素分析有统计学意义的指标均为老年CNF患者预后的独立影响因素(P<0.05或0.01)。

结论

并发下行性胸膜炎、糖尿病、24 h内出现感染性休克、出现3种以上并发症及病程长是导致老年CNF死亡的主要危险因素,而教育程度高、家庭收入高及早期彻底清创引流并联合敏感抗生素治疗对降低老年CNF的死亡风险有积极意义。

Objective

To investigate the prognostic factors of cervical necrotizing fasciitis (CNF) in the elderly.

Methods

The complete data of 35 elderly patients with cervical necrotizing fasciitis admitted to the Affiliated Hospital of Yangzhou University from January 2006 to December 2018 were analyzed, and the clinical data of postoperative dead patients and surviving patients were compared. The statistically significant indicators of univariate analysis were substituted into the multivariate Logistic regression model for multivariate analysis.

Results

Among 35 patients, 9 died (death group) and 26 survived (survival group) 3~10(6.8±1.3) days after operation. There were statistically significant differences in course of disease, red blood cell and white blood cell count, blood glucose level, high-sensitivity C-reactive protein level, hemoglobin level, debridement within 24 hours, shock within 24 hours, descending pleurisy within 48 hours, types of complications, education level, drug-resistant bacteria and family income between the two groups (P < 0.05 or 0.01). Logistic multiple regression analysis showed that the indicators with statistical significance in univariate analysis were independent prognostic factors in elderly patients with CNF (P < 0.05 or 0.01).

Conclusion

Concurrent descending pleurisy, diabetes, septic shock within 24 h, more than 3 complications and long course of disease were the main risk factors leading to the death of CNF in the elderly, while high education level, high family income, early complete debridement and drainage combined with sensitive antibiotics had positive significance for reducing the death risk of CNF in the elderly.

图1 老年颈坏死性筋膜炎颈部轴位CT特征性表现。右侧颈间隙内出现沿筋膜分布的大量气体,气体将周围筋膜撕裂、边缘不齐(图中箭头处)
图2 CT引导下穿刺引流手术后放置的引流管(图中箭头处)
表1 死亡与存活老年颈部坏死性筋膜炎患者计量资料的比较
表2 死亡与存活老年颈部坏死性筋膜炎患者计数资料的比较
表3 老年颈坏死性筋膜炎患者预后的多元素回归分析
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