口腔颌面部间隙感染患者预后不良的影响因素分析

doi:10.3969/j.issn.1005-4979.2022.01.009

摘要/Abstract

摘要：

目的：探讨口腔颌面部间隙感染患者不良结局的发生情况及相关影响因素，为其治疗和预防提供参考。方法：选择长沙市第四医院2011年1月—2020年6月收治的口腔颌面部间隙感染的患者为研究对象。通过医院信息管理系统（hospital information system，HIS）收集患者的临床资料，采用描述流行病学分析方法进行分析，采用单因素分析和多因素Logistic线性回归方法对口腔颌面部间隙感染患者不良结局的相关影响因素进行分析。结果：共收集到249例口腔颌面部间隙感染患者的临床资料，其中32例出现不良结局，发生率为12.85%，其中发生相关严重并发症27例、放弃治疗3例、死亡2例。多因素Logistic回归分析结果显示，年龄越大（OR=0.563）、感染至就诊时间越长（OR=1.324）、累及间隙越多（OR=0.441）、呼吸困难（OR=1.715）、合并糖尿病（OR=2.261）、中性粒细胞计数>0.9×10⁹/L（OR=1.505）、C-反应蛋白≥10 mg/mL（OR=2.231）是口腔颌面部间隙感染患者发生不良结局的危险因素。结论：口腔颌面部间隙感染患者不良结局的发生率较高，与年龄、感染至就诊时间、累及间隙情况、呼吸困难、合并糖尿病、中性粒细胞计数和C-反应蛋白水平等因素有高相关性，临床应针对存在这些危险因素的患者加强干预和监护。

关键词: 口腔颌面部间隙感染, 不良结局, 单因素分析, 多因素Logistic回归分析

Abstract:

Objective: To investigate the occurrence and influencing factors of adverse outcomes in patients with oral and maxillofacial space infection, and to provide references for prevention and treatment. Methods: A total of 249 patients with oral and maxillofacial space infection treated in the Fourth Hospital of Changsha from January 2011 to June 2020 were selected as the research subjects. Clinical data of patients were collected according to hospital information system (HIS). Descriptive epidemiological analysis was used to analyze the adverse outcomes in patients with oral and maxillofacial space infection, and the influencing factors were analyzed by univariate analysis and multivariate logistic regression method. Results: Among 249 patients, 32 of them had adverse outcomes, and the incidence rate was 12.85%. 27 patients had serious complications, 3 cases abandoned treatment, and 2 cases died. Multivariate logistic regression analysis showed that older age (OR=0.563), longer interval from infection to treatment (OR=1.324), more involved spaces (OR=0.441), dyspnea (OR=1.715), diabetes (OR=2.261), neutrophil count>0.9×10⁹/L (OR=1.505), and C-reactive protein≥10 mg/mL (OR=2.231) were risk factors for adverse outcomes in patients with oral and maxillofacial space infection. Conclusion: Patients with oral and maxillofacial space infection have a relatively high occurrence of adverse outcomes. The incidence is closely associated with age, interval from infection to treatment, involved space, dyspnea, diabetes, neutrophil count, and C-reactive protein. Clinical intervention and monitoring should be strengthened for patients with high risk factors.

Key words: oral and maxillofacial space infection, adverse outcomes, univariate analysis, multivariate logistic regression method

唐圣斌, 李琴, 雷邓. 口腔颌面部间隙感染患者预后不良的影响因素分析[J]. 《口腔颌面外科杂志》, 2022, 32(1): 46-50.

TANG Shengbin, LI Qin, LEI Deng. Analysis of adverse factors in patients with oral and maxillofacial space infection[J]. 《Journal of Oral and Maxillofacial Surgery》, 2022, 32(1): 46-50.

https://journal06.magtech.org.cn/Jweb_joms/CN/Y2022/V32/I1/46

图/表 2

参考文献 21

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项目	分类	例数	构成比/%	不良结局例数	发生率/%	χ²值	P值
性别	男	155	62.25	21	13.55	0.178	>0.05
	女	94	37.75	11	11.70
年龄/岁	18~40	55	22.09	3	5.45	12.894	<0.05
	41~60	126	50.60	12	9.52
	>60	68	27.31	17	25.00
BMI/（kg·m^-2）	<20	26	10.44	2	7.69	2.623	>0.05
	20~25	177	71.08	21	11.86
	>25	46	18.47	9	19.57
感染至就诊时间/d	<7	131	52.61	10	7.63	11.098	<0.05
	7~14	83	33.33	12	14.46
	>14	35	14.06	10	28.57
住院时间/d	<7	122	49.00	10	8.20	10.405	<0.05
	7~14	114	45.78	17	14.91
	>14	13	5.22	5	38.46
感染原因	牙源性	129	51.81	16	12.40	0.404	>0.05
	腺源性	50	20.08	7	14.00
	损伤性	38	15.26	5	13.16
	医源性	17	6.83	2	11.76
	血源性	10	4.02	1	10.00
	其他	5	2.01	1	20.00
累及间隙	单间隙	70	28.11	3	4.29	6.379	<0.05
	多间隙	179	71.89	29	16.20
致病菌分布	单一致病菌	52	20.88	2	3.85	4.759	<0.05
	多重致病菌	197	79.12	30	15.23
呼吸困难	是	78	31.33	15	19.23	4.127	<0.05
	否	171	68.67	17	9.94
吞咽困难	是	52	20.88	10	19.23	2.388	>0.05
	否	197	79.12	22	11.17
糖尿病	是	97	38.96	18	18.56	4.618	<0.05
	否	152	61.04	14	9.21
高血压	是	88	35.34	17	19.32	5.082	<0.05
	否	161	64.66	15	9.32
冠心病	是	39	15.66	7	17.95	1.073	>0.05
	否	210	84.34	25	11.90
切开引流	是	197	79.12	22	11.17	2.388	>0.05
	否	52	20.88	10	9.23
白细胞计数（×10⁹）/L^-1	<10	28	11.24	1	3.57	7.094	<0.05
	10~20	131	52.61	13	9.92
	>20	90	36.14	18	20.00
中性粒细胞计数（×10⁹）/L^-1	<0.7	63	25.30	5	7.94	6.003	<0.05
	0.7~0.9	144	57.83	17	11.81
	>0.9	42	16.87	10	23.81
C-反应蛋白/（mg·L^-1）	<10	158	63.45	14	8.86	6.147	<0.05
	≥10	91	36.55	18	19.78

项目	分类	例数	构成比/%	不良结局例数	发生率/%	χ²值	P值
性别	男	155	62.25	21	13.55	0.178	>0.05
	女	94	37.75	11	11.70
年龄/岁	18~40	55	22.09	3	5.45	12.894	<0.05
	41~60	126	50.60	12	9.52
	>60	68	27.31	17	25.00
BMI/（kg·m^-2）	<20	26	10.44	2	7.69	2.623	>0.05
	20~25	177	71.08	21	11.86
	>25	46	18.47	9	19.57
感染至就诊时间/d	<7	131	52.61	10	7.63	11.098	<0.05
	7~14	83	33.33	12	14.46
	>14	35	14.06	10	28.57
住院时间/d	<7	122	49.00	10	8.20	10.405	<0.05
	7~14	114	45.78	17	14.91
	>14	13	5.22	5	38.46
感染原因	牙源性	129	51.81	16	12.40	0.404	>0.05
	腺源性	50	20.08	7	14.00
	损伤性	38	15.26	5	13.16
	医源性	17	6.83	2	11.76
	血源性	10	4.02	1	10.00
	其他	5	2.01	1	20.00
累及间隙	单间隙	70	28.11	3	4.29	6.379	<0.05
	多间隙	179	71.89	29	16.20
致病菌分布	单一致病菌	52	20.88	2	3.85	4.759	<0.05
	多重致病菌	197	79.12	30	15.23
呼吸困难	是	78	31.33	15	19.23	4.127	<0.05
	否	171	68.67	17	9.94
吞咽困难	是	52	20.88	10	19.23	2.388	>0.05
	否	197	79.12	22	11.17
糖尿病	是	97	38.96	18	18.56	4.618	<0.05
	否	152	61.04	14	9.21
高血压	是	88	35.34	17	19.32	5.082	<0.05
	否	161	64.66	15	9.32
冠心病	是	39	15.66	7	17.95	1.073	>0.05
	否	210	84.34	25	11.90
切开引流	是	197	79.12	22	11.17	2.388	>0.05
	否	52	20.88	10	9.23
白细胞计数（×10⁹）/L^-1	<10	28	11.24	1	3.57	7.094	<0.05
	10~20	131	52.61	13	9.92
	>20	90	36.14	18	20.00
中性粒细胞计数（×10⁹）/L^-1	<0.7	63	25.30	5	7.94	6.003	<0.05
	0.7~0.9	144	57.83	17	11.81
	>0.9	42	16.87	10	23.81
C-反应蛋白/（mg·L^-1）	<10	158	63.45	14	8.86	6.147	<0.05
	≥10	91	36.55	18	19.78

变量	Β	SE	Wald χ²值	P值	OR值	OR值（95%CI）
年龄/岁（18~40岁为参照）
41~60	0.892	0.513	2.714	>0.05	0.489	0.133~1.217
>60	1.631	0.695	6.910	<0.05	0.563	0.273~3.454
感染至就诊时间/d（<7 d为参照）
7~14	0.921	0.639	5.829	<0.05	0.230	0.104~1.276
>14	1.753	0.547	8.910	<0.05	1.324	0.866~4.764
累及间隙（单间隙为参照）	0.827	0.375	6.933	<0.05	0.441	0.251~1.836
呼吸困难（否为参照）	1.408	0.722	9.746	<0.05	1.715	1.387~3.159
合并糖尿病（否为参照）	1.115	0.457	10.733	<0.05	2.261	1.505~2.813
中性粒细胞计数(×10⁹)/L^-1（<0.7×10⁹/L为参照）
0.7~0.9	1.744	0.684	3.733	>0.05	0.902	1.154~4.585
>0.9	1.237	0.732	9.403	<0.05	1.505	0.938~2.820
C-反应蛋白/（mg·L^-1）（<10 mg/L为参照）	1.408	0.684	9.822	<0.05	2.231	1.725~4.465

变量	Β	SE	Wald χ²值	P值	OR值	OR值（95%CI）
年龄/岁（18~40岁为参照）
41~60	0.892	0.513	2.714	>0.05	0.489	0.133~1.217
>60	1.631	0.695	6.910	<0.05	0.563	0.273~3.454
感染至就诊时间/d（<7 d为参照）
7~14	0.921	0.639	5.829	<0.05	0.230	0.104~1.276
>14	1.753	0.547	8.910	<0.05	1.324	0.866~4.764
累及间隙（单间隙为参照）	0.827	0.375	6.933	<0.05	0.441	0.251~1.836
呼吸困难（否为参照）	1.408	0.722	9.746	<0.05	1.715	1.387~3.159
合并糖尿病（否为参照）	1.115	0.457	10.733	<0.05	2.261	1.505~2.813
中性粒细胞计数(×10⁹)/L^-1（<0.7×10⁹/L为参照）
0.7~0.9	1.744	0.684	3.733	>0.05	0.902	1.154~4.585
>0.9	1.237	0.732	9.403	<0.05	1.505	0.938~2.820
C-反应蛋白/（mg·L^-1）（<10 mg/L为参照）	1.408	0.684	9.822	<0.05	2.231	1.725~4.465

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