摘要：
背景与目的 纵隔感染是累及纵隔结缔组织的严重感染,并发症较多且死亡率较高;治疗上应用广谱抗生素及营养支持外,早期充分引流为成功救治的关键;在引流方式上,我们应用持续负压引流技术治疗严重口咽部来源的急性前纵隔感染取得较好效果,在此予以总结分享.方法 2017年1月-12月我院共收治17例来源于口咽部急性纵隔感染,已形成纵隔脓肿,手术均采用胸骨后对口负压引流方式,即经胸骨上窝及剑突下切口游离胸骨后前纵隔间隙,使之贯通并放置引流装置,缝合封闭创口,持续负压引流,负压采用3 cm-5 cm水柱.结果 17例患者中,14例患者经持续负压引流引流液清亮感染消退,然后拔除引流管;2例患者感染破溃入右侧胸腔,行闭式引流术导致负压消失,放弃负压引流改用常规引流,引流管液体清亮后拔除引流管;1例患者已经形成纵膈脓肿切开引流时间较晚,并发感染性休克、脓毒血症,最终导致多器官功能衰竭死亡.结论 严重急性纵隔感染传统的治疗方法是胸骨切开引流,患者创伤大、心理难以承受,且医生工作负担较重;持续负压引流术减轻患者痛苦、能够充分引流纵隔积液,并且避免了敷料反复渗出而需要的换药,对治疗严重急性前纵隔感染是一种有效的方法.但该方法对中、后纵隔引流存在局限性,有待进一步优化.%Background and objective Mediastinal infection is a serious infection of mediastinal connective tissue, with more complications and higher mortality. Application of broad-spectrum antibiotics and nutritional support, early sufficient drainage is the key to successful treatment. In the mode of drainage, this paper discusses the application of continuous negative pressure drainage technique to treat acute anterior mediastinal infection of severe mouth pharynx source, and the good results are summarized and shared. Methods In January to December in 2017, a total of 17 cases treated acute mediastinal infection is derived from the throat, has formed a mediastinal abscess, surgery adopts retrosternal counterpart negative pressure drainage way, namely the sternum nest and free sternum xiphoid process under the incision on the first mediastinal clearance, make breakthrough and placed drainage device, suture closed wound, continuous negative pressure drainage, negative pressure using 3 cm-5 cm water column. Results Among the 17 patients, 14 patients were relieved by continuous negative pressure drainage, and then the drainage tube was removed. In 2 cases, the infection broke into the right thoracic cavity, and the closed drainage caused the negative pressure to disappear, and the negative pressure drainage was replaced by the conventional drainage, and the drainage tube was removed after the drainage tube was clear. One patient had formed a mediastinal abscess incision drainage time later, complicated with septic shock and sepsis, resulting in the death of multiple organ failure. Conclusion The traditional treatment of severe acute mediastinal infection is sternal incision and drainage. Continuous negative pressure drainage adequate drainage of mediastinal can relieve patients' pain, effusion, and avoid the dressing out repeatedly. It is an effective method. However, there are limitations in this method, which need to be further optimized.
