摘要
目的 总结新生儿眶蜂窝织炎临床特点和治疗.方法 回顾性病例系列研究.收集分析 2000 年 1 月至 2024 年 2 月郑州大学第一附属医院新生儿科收治的 3 例新生儿眶蜂窝织炎患儿的临床资料.以"新生儿""眶蜂窝织炎""眼眶脓肿"为关键词检索中国知网、万方数据库、中华医学期刊全文数据库、维普数据库,以"neonate or newborn""orbital cellulitis""orbital abscess"为关键词检索PubMed、Embase和Web of Science数据库自建库至 2024 年 2 月收录的相关文献,总结新生儿眶蜂窝织炎的临床特点、诊疗经过及预后.结果 本院共收治新生儿眶蜂窝织炎 3 例,均为足月儿.其中男性 2 例,女性 1 例,诱因分别为鼻泪管阻塞、筛窦炎、上呼吸道感染,临床表现为发热伴单侧眼睑红肿,给予抗感染治疗,1 例好转,2 例进行性加重,出现眼球突出伴运动障碍,完善眼眶CT合并局部脓肿,予以眶切开术脓肿引流后好转.最终检索到 44 篇符合标准的文献,结合本组 3 例患儿,共 60 例.其中男性 31 例,女性 29 例;46 例为足月儿(76.7%,46/60),50 例单侧眼睛受累(83.3%,50/60),诱因为筛窦炎者 14 例(23.3%,14/60).临床表现为发热者 41 例(68.3%,41/60)、眼睑红肿者 60 例(100.0%,60/60)、眼球突出者 46 例(76.7%,46/60)、眼球运动障碍者 35 例(58.3%,35/60).微生物培养结果为金黄色葡萄球菌者 48 例(80.0%,48/60),包括 13 例耐甲氧西林金黄色葡萄球菌(MRSA),7 例早产儿中 6 例培养出MRSA(85.7%,6/7).50 例患儿(83.3%,50/60)合并脓肿.13 例(21.7%,13/60)患儿接受了内科治疗,44 例(73.3%,44/60)患儿接受了内科治疗+脓肿引流,3 例(5.0%,3/60)患儿在内科治疗中脓肿自发破溃.死亡 3 例,存活 57 例,其中 2 例患儿短期随访存在后遗症.结论 新生儿眶蜂窝织炎多见于足月儿,最常见的诱因是筛窦炎,微生物培养多为金黄色葡萄球菌,临床以发热、眼睑红肿、眼球突出、运动障碍为主要表现,且易合并脓肿,对存在确切脓肿的病例应及时外科引流.
Abstract
Objective To summarize the clinical features and treatment of neonatal orbital cellulitis.Methods This was a retrospective case series study.The clinical data of 3 neonates with orbital cellulitis admitted to the Department of Neonatology of the First Affiliated Hospital of Zhengzhou University from Jan.2000 to Feb.2024 were analyzed."Newborn","orbital cellulitis",and"orbital abscess"were used as keywords to search the China National knowledge Infrastructure(CNKI),Wanfang database,Chinese Medical Journal full-text database,VIP database,PubMed,Embase,and the Web of Science database.Relevant literatures published up to Feb.2024 were retrieved to summarize the clinical features,diagnosis and treatment,and prognosis of neonatal orbital cellulitis.Results A total of 3 cases of neonatal orbital cellulitis were treated in our hospital,all of which were full-term infants.There were 2 males and 1 female.The inducements were nasolacrimal duct obstruction,ethmoiditis,and upper respiratory tract infection,respectively.The clinical manifestations were fever,accompanied by unilateral eyelid redness and swelling.Anti-infection treatment was given with 1 case improved.However,the symptoms were aggravated progressively in 2 cases,accompanied with exophthalmos and dyskinesia,which improved after drainage of orbital abscess revealed by Orbital CT.Finally,44 literatures meeting the criteria were retrieved,and the total number reached 60 cases after including the 3 cases from our hospital.There were 31 males and 29 females.Fourty-six cases were full-term infants(76.7%,46/60),and 50 cases were unilateral eye involvement(83.3%,50/60),and 14 cases(23.3%,14/60)were induced by ethmoiditis.The clinical manifestations were fever in 41 cases(68.3%,41/60),eyelid swelling in 60 cases(100.0%,60/60),exophthalmos in 46 cases(76.7%,46/60),and eye movement disorders in 35 cases(58.3%,35/60).The results of microbial culture were Staphylococcus aureus in 48 cases(80.0%,48/60),including 13 cases of Methicillin-resistant Staphyloccus aureus(MRSA),and MRSA was cultured from 6 out of 7 premature infants(85.7%,6/7).There were 50 patients(83.3%,50/60)with abscess.Thirteen cases(21.7%,13/60)received medical treatment,and 44 cases(73.3%,44/60)received medical treatment and drainage of the abscess,and 3 cases(5.0%,3/60)had spontaneous abscess drainage during medical treatment.There were 3 deaths and 57 survivors,with sequelae found in 2 cases during short-term follow-up.Conclusion Neonatal orbital cellulitis is more common in term infants.Ethmoiditis is the most common cause,and the microbial cultures are mostly Staphylococcus aureus.The main clinical manifestations are fever,eyelid redness,exophthalmos,and eye movement disorder,and they are aften complicated with abscess.Surgical drainage should be done timely for cases with definite abscess.
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