指南与共识
ENGLISH ABSTRACT
口腔颌面部间隙感染诊疗专家共识
李云鹏
石冰
张浚睿
刘彦普
沈国芳
郭传瑸
杨驰
李祖兵
张志光
王慧明
卢利
胡开进
季平
许彪
张伟
刘静明
龚忠诚
任战平
田磊
袁华
张惠
马婕
孔亮
作者及单位信息
·
DOI: 10.3760/cma.j.cn112144-20200323-00169
Expert consensus on the treatment of oral and maxillofacial space infections
Li Yunpeng
Shi Bing
Zhang Junrui
Liu Yanpu
Shen Guofang
Guo Chuanbin
Yang Chi
Li Zubing
Zhang Zhiguang
Wang Huiming
Lu Li
Hu Kaijin
Ji Ping
Xu Biao
Zhang Wei
Liu Jingming
Gong Zhongcheng
Ren Zhanping
Tian Lei
Yuan Hua
Zhang Hui
Ma Jie
Kong Liang
Authors Info & Affiliations
Li Yunpeng
Department of Oral and Maxillofacial Surgery, School of Stomatology, The Fourth Military Medical University & State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Clinical Research Center for Oral Diseases, Xi′an 710032, China
Shi Bing
Department of Cleft Lip and Palate Surgery, West China Hospital of Stomatology, Sichuan University & State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, Chengdu 610041, China
Zhang Junrui
Department of Oral and Maxillofacial Surgery, School of Stomatology, The Fourth Military Medical University & State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Clinical Research Center for Oral Diseases, Xi′an 710032, China
Liu Yanpu
Department of Oral and Maxillofacial Surgery, School of Stomatology, The Fourth Military Medical University & State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Clinical Research Center for Oral Diseases, Xi′an 710032, China
Shen Guofang
Shanghai University of Medicine & Health Sciences, Shanghai 200120, China
Guo Chuanbin
Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
Yang Chi
Department of Oral and Maxillofacial Surgery, Ninth People′s Hospital, Shanghai Jiao Tong University School of Medicine & Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology & National Clinical Research Center of Stomatology, Shanghai 200011, China
Li Zubing
Department of Oral and Maxillofacial Trauma and Plastic Surgery, School of Stomatology, Wuhan University, Wuhan 430079, China
Zhang Zhiguang
Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University & Guangdong Provincial Key Laboratory of Stomatology, Guangzhou 510055, China
Wang Huiming
Department of Oral Implantology, The Affiliated Hospital of Stomatology, School of Stomatology, Zhejiang University School of Medicine, and Key Laboratory of Oral Biomedical Research of Zhejiang Province, Hangzhou 310006, China
Lu Li
Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, China Medical University, Liaoning Provincial Key Laboratory of Oral Diseases, Shenyang 110002, China
Hu Kaijin
Department of Oral and Maxillofacial Surgery, School of Stomatology, The Fourth Military Medical University & State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Clinical Research Center for Oral Diseases, Xi′an 710032, China
Ji Ping
Department of Oral Implantology, Stomatological Hospital of Chongqing Medical University & Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences & Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing 401147, China
Xu Biao
Department of Oral and Maxillofacial Surgery, The Affiliated Stomatological Hospital of Kunming Medical University, Kunming 650000, China
Zhang Wei
Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
Liu Jingming
Department of Oral and Maxillofacial Surgery, Capital Medical University School of Stomatology, Beijing 100050, China
Gong Zhongcheng
Oncological Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China
Ren Zhanping
Department of Oral and Maxillofacial Surgery, College of Stomatology, Xi′an Jiaotong University, Xi′an 710004, China
Tian Lei
Department of Oral and Maxillofacial Surgery, School of Stomatology, The Fourth Military Medical University & State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Clinical Research Center for Oral Diseases, Xi′an 710032, China
Yuan Hua
Department of Rehabilitation Medicine, Xijing Hospital, The Fourth Military Medical University, Xi′an 710032, China
Zhang Hui
Department of Anethesiology, School of Stomatology, The Fourth Military Medical University & State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Engineering Research Center for Dental Materials and Advanced Manufacture, Xi′an 710032, China
Ma Jie
Department of Oral and Maxillofacial Surgery, School of Stomatology, The Fourth Military Medical University & State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Clinical Research Center for Oral Diseases, Xi′an 710032, China
Kong Liang
Department of Oral and Maxillofacial Surgery, School of Stomatology, The Fourth Military Medical University & State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Clinical Research Center for Oral Diseases, Xi′an 710032, China
·
DOI: 10.3760/cma.j.cn112144-20200323-00169
9080
2006
0
11
138
39
PDF下载
APP内阅读
摘要

口腔颌面部间隙感染(oral and maxillofacial space infections,OMSI)是颌面部潜在筋膜间隙的感染,是口腔颌面部的常见疾病。OMSI病例具有耐药菌感染增多、重症感染增多、致死风险增加等特点。为提高OMSI的治愈率,其治疗原则与方法需与时俱进。因此,依据国内部分专家当前诊治OMSI的临床经验,结合国际同行治疗经验,本文从术前检查、检查结果解读、经验性用药原则、手术处理原则、术后换药原则、智齿冠周炎相关间隙感染的防治策略、血糖监测与控制、物理因子治疗原则、路德维希咽峡炎治疗和围手术期护理等10个方面进行系统性总结,形成共识,以期逐步实现我国口腔颌面外科同行诊治OMSI的规范化与标准化,最终达到提高我国OMSI的诊疗水平的目的。

感染;口腔颌面部间隙;诊疗技术;专家共识
ABSTRACT

Oral and maxillofacial space infections (OMSI) are common diseases of the facial region involving fascial spaces. Recently, OMSI shows trends of multi drug-resistance, severe symptoms, and increased mortality. OMSI treatment principles need to be updated to improve the cure rate. Based on the clinical experiences of Chinese experts and with the incorporation of international counterparts′ expertise, the principles of preoperative checklist, interpretation of examination results, empirical medication principles, surgical treatment principles, postoperative drainage principles, prevention strategies of wisdom teeth pericoronitis-related OMSI, blood glucose management, physiotherapy principles, Ludwig′s angina treatment and perioperative care were systematically summarized and an expert consensus on the diagnosis and treatment of OMSI was reached. The consensus aims to provide criteria for the diagnosis and treatment of OMSI in China so as to improve the level of OMSI treatment.

Infection;Oral and maxillofacial space;Diagnosis and treatment;Expert consensus
Kong Liang, Email: nc.defudabe.ummfgnailgnok; Tel: 0086-29-84776107
引用本文

李云鹏,石冰,张浚睿,等. 口腔颌面部间隙感染诊疗专家共识[J]. 中华口腔医学杂志,2021,56(02):136-144.

DOI:10.3760/cma.j.cn112144-20200323-00169

PERMISSIONS

Request permissions for this article from CCC.

评价本文
*以上评分为匿名评价
口腔颌面部间隙感染(oral and maxillofacial space infections,OMSI)是颌面部潜在筋膜间隙的感染,是口腔颌面部的常见疾病之一 1。根据解剖结构和临床表现可分为:咬肌间隙、翼下颌间隙、颞下间隙、颞间隙、下颌下间隙、咽旁间隙、颊间隙和口底间隙感染等。OMSI临床表现可分为局部症状和全身症状。局部症状包括急性期的皮肤发红(发紫)、肿胀、疼痛、皮温升高、发音吞咽困难、张口受限、凹陷性水肿、捻发音等,慢性期的功能障碍、长期排脓的窦(瘘)口等。全身症状包括畏寒、发热、头痛、全身不适、乏力及食欲减退等。OMSI的诊断主要根据发病原因、临床表现、实验室检查和影像学检查等综合判断。OMSI的治疗包括抗感染治疗、手术治疗、全身支持治疗和辅助治疗,其中手术治疗是主要手段,术后冲洗换药也对病情控制起重要作用 2。OMSI的治疗需多学科参与,体现以口腔颌面外科为主,包含麻醉科、急诊科、重症医学科、心胸外科、眼科、儿科以及相关内科等多学科协作诊疗的特点 3。对涉及颅内、眼眶、纵隔,或病情严重有中毒性休克、多器官功能衰竭风险的患者,建议转至综合医院相关科室,口腔颌面外科积极配合治疗。
目前国内外尚无OMSI治疗的统一规范,基层临床医务人员在接诊此类患者时乏据可依,出现“诊治无序,延误时机”的情况。由于治疗方案欠缺规范,治疗效果不一,给患者带来不必要的痛苦,同时造成大量医疗资源浪费。在口腔医学各专业蓬勃发展,新技术新材料层出不穷的时代背景下,OMSI的治疗及其相关研究领域发展相对滞后,逐渐成为整个口腔医学中的一块短板。因此,由第四军医大学口腔医学院口腔颌面外科牵头组织,联合国内多家口腔院校专家,经过多次讨论和修订,共同制定了“口腔颌面部间隙感染诊疗专家共识”。通过对术前检查、检查结果解读、经验性用药原则、手术处理原则、术后换药原则、智齿冠周炎相关间隙感染的防治策略、血糖监测与控制、物理因子治疗原则、路德维希咽峡炎和围手术期护理共10个方面的讨论,规范此类疾病的诊断、治疗及康复的标准化流程,提高OMSI的治愈率。
试读结束,您可以通过登录机构账户或个人账户后获取全文阅读权限。
参考文献
1
张志愿. 口腔颌面外科学[M]. 北京:人民卫生出版社, 2012.
Zhang ZY . Oral and maxillofacial surgery[M]. Beijing:People′s Medical Publishing House, 2012.
2
龚菊,许彪. 口腔颌面部间隙感染诊治的研究进展[J]. 医学综述, 2018,24(8):1560-1564.
返回引文位置Google Scholar
百度学术
万方数据
Gong J , Xu B . Research progress in diagnosis and treatment of oral and maxillofacial space infection[J]. Medical Recapitulate, 2018,24(8):1560-1564.
Goto CitationGoogle Scholar
Baidu Scholar
Wanfang Data
3
张方明. 口腔多学科协作诊疗体系的构建与实施[J]. 中华口腔医学杂志, 2020,55(10):722-728. DOI: 10.3760/cma.j.cn112144-20200420-00219 .
返回引文位置Google Scholar
百度学术
万方数据
Zhang FM . Construction and implementation of oral multidisciplinary team system[J]. Chin J Stomatol, 2020,55(10):722-728. DOI: 10.3760/cma.j.cn112144-20200420-00219 .
Goto CitationGoogle Scholar
Baidu Scholar
Wanfang Data
4
赵小珩,郭威孝,张浚睿,. 口腔颌面部间隙感染的管理(三): 实验室检查[J]. 实用口腔医学杂志, 2018,34(3):424-429.
返回引文位置Google Scholar
百度学术
万方数据
Zhao XH , Guo WX , Zhang JR ,et al. Management of oral and maxillofacial space infections (3): laboratory examination[J]. J Pract Stomatol, 2018,34(3):424-429.
Goto CitationGoogle Scholar
Baidu Scholar
Wanfang Data
5
陈孝平,汪建平,赵继宗. 外科学[M]. 北京:人民卫生出版社, 2018.
Chen XP , Wang JP , Zhao JZ . Surgery[M]. Beijing:People′s Medical Publishing House, 2018.
6
中国医药教育协会感染疾病专业委员会. 感染相关生物标志物临床意义解读专家共识[J]. 中华结核和呼吸杂志, 2017,40(4):243-257. DOI: 10.3760/cma.j.issn.1001-0939.2017.04.002 .
返回引文位置Google Scholar
百度学术
万方数据
Committee of Infectious Diseases, China Medical Education Association. Expert consensus on interpretation of clinical significance of infection-related biomarkers[J]. Chin J Tuberc Respir Dis, 2017,40(4):243-257. DOI: 10.3760/cma.j.issn.1001-0939.2017.04.002 .
Goto CitationGoogle Scholar
Baidu Scholar
Wanfang Data
7
尹小朋,许慧芬,辜文妍,. CRP、PCT、IL-6、WBC测定对颌面部间隙感染的诊断价值及治疗指导的意义[J]. 口腔医学, 2019,39(12):1085-1089.
返回引文位置Google Scholar
百度学术
万方数据
Yin XP , Xu HF , Gu WY ,et al. Diagnostic value and therapeutic significance of CRP, PCT, IL-6 and WBC for maxillofacial space infection[J]. Stomatology, 2019,39(12):1085-1089.
Goto CitationGoogle Scholar
Baidu Scholar
Wanfang Data
8
夏韫晖,曲禄瑶,梁翔,. C反应蛋白在下行性坏死性纵隔炎中的预警作用[J]. 中国口腔颌面外科杂志, 2019,17(3):257-260.
返回引文位置Google Scholar
百度学术
万方数据
Xia YH , Qu LY , Liang X ,et al. Early-warning function of C-reactive protein in diagnosis of descending necrotic mediastinitis[J]. China J Oral Maxillofac Surg, 2019,17(3):257-260.
Goto CitationGoogle Scholar
Baidu Scholar
Wanfang Data
9
降钙素原急诊临床应用专家共识组. 降钙素原(PCT)急诊临床应用的专家共识[J]. 中华急诊医学杂志, 2012,21(9):944-951.
返回引文位置Google Scholar
百度学术
万方数据
Expert consensus group on the emergency clinical use of procalcitonin. Expert consensus on the emergency clinical application of procalcitonin (PCT)[J]. Chin J Emerg Med, 2012,21(9):944-951.
Goto CitationGoogle Scholar
Baidu Scholar
Wanfang Data
10
李云鹏,杨鹏,邢影,. 颌面部间隙感染的管理(五): 糖尿病患者伴发间隙感染诊治经验[J]. 实用口腔医学杂志, 2018,34(5):717-720.
返回引文位置Google Scholar
百度学术
万方数据
Li YP , Yang P , Xing Y ,et al. Management of oral and maxillofacial space infections (5): experience in diagnosis and treatment of space infection in diabetic patients[J]. J Pract Stomatol, 2018,34(4):717-720.
Goto CitationGoogle Scholar
Baidu Scholar
Wanfang Data
11
中华医学会重症医学分会. 中国严重脓毒症/脓毒性休克治疗指南(2014)[J]. 中华内科杂志, 2015,54(6):557-581. DOI: 10.3760/cma.j.issn.0578-1426.2015.06.021 .
返回引文位置Google Scholar
百度学术
万方数据
Chinese Critical Medicine Society. Gui delines for the treatment of severe sepsis/septic shock in China (2014) [J]. Chin J Intern Med, 2015,54(6):557-581. DOI: 10.3760/cma.j.issn.0578-1426.2015.06.021 .
Goto CitationGoogle Scholar
Baidu Scholar
Wanfang Data
12
国家卫生和计划生育委员会,国家中医药管理局,解放军总后勤部卫生部. 抗菌药物临床应用指导原则(2015年版)[M]. 北京:人民卫生出版社, 2015.
National Health and Family Planning Commission of the People′s Republic of China,State Administration of Traditional Chinese Medicine of the People′s Republic of China,Medical Department of the People′s Liberation Army General Logistics Department. Guideline principles for clinical use of antibiotic (version 2015)[M]. Beijing:People′s Medical Publishing House, 2015.
13
史宗道. 口腔临床药物学[M]. 北京:人民卫生出版社, 2012.
Shi ZD . Oral clinical pharmacology[M]. Beijing:People′s Medical Publishing House, 2012.
14
Krasner D . Wound care: how to use the red-yellow-black system[J]. Am J Nurs, 1995(5):44-47.
返回引文位置Google Scholar
百度学术
万方数据
15
胡开进. 标准拔牙手术图谱[M]. 北京:人民卫生出版社, 2010.
Hu KJ . Atlas of standard protocol for tooth extraction[M]. Beijing:People′s Medical Publishing House, 2010.
16
中华医学会糖尿病学分会. 中国2型糖尿病防治指南(2017年版)[J]. 中华糖尿病杂志, 2018,10(1):4-67. DOI: 10.3760/cma.j.issn.1674-5809.2018.01.003 .
返回引文位置Google Scholar
百度学术
万方数据
Chinese Diabetes Society. Guidelines for the prevention and control of type 2 diabetes in China (2017 Edition)[J]. Chin J Diabetes Mellitus, 2018,10(1):4-67. DOI: 10.3760/cma.j.issn.1674-5809.2018.01.003 .
Goto CitationGoogle Scholar
Baidu Scholar
Wanfang Data
17
Mohamad I , Narayanan MS . "Double tongue" appearance in Ludwig′s angina[J]. N Engl J Med, 2019,381(2):163. DOI: 10.1056/NEJMicm1814117 .
返回引文位置Google Scholar
百度学术
万方数据
备注信息
A
孔亮,Email: nc.defudabe.ummfgnailgnok,电话:029-84776107
B

李云鹏:直接参与文章设计、参与酝酿和设计、统计分析、文章撰写;石冰、张浚睿、刘彦普、沈国芳、郭传瑸、杨驰、李祖兵、张志光、王慧明、卢利、胡开进、季平、许彪、张伟、刘静明、龚忠诚、任战平、田磊、袁华、张惠、马婕:文章审阅、对文章提出指导性意见;孔亮:直接参与文章设计、指导文章修改

C

李云鹏, 石冰, 张浚睿, 等. 口腔颌面部间隙感染诊疗的专家共识[J]. 中华口腔医学杂志, 2021, 56(2): 136-144. DOI: 10.3760/cma.j.cn112144-20200323-00169.

D
所有作者均声明不存在利益冲突
评论 (0条)
注册
登录
时间排序
暂无评论,发表第一条评论抢沙发
MedAI助手(体验版)
文档即答
智问智答
机器翻译
回答内容由人工智能生成,我社无法保证其准确性和完整性,该生成内容不代表我们的态度或观点,仅供参考。
生成快照
文献快照

你好,我可以帮助您更好的了解本文,请向我提问您关注的问题。

0/2000

《中华医学会杂志社用户协议》 | 《隐私政策》

《SparkDesk 用户协议》 | 《SparkDesk 隐私政策》

网信算备340104764864601230055号 | 网信算备340104726288401230013号

技术支持:

历史对话
本文全部
还没有聊天记录
设置
模式
纯净模式沉浸模式
字号