乳腺炎:快速证据审查。

IF 3.8 3区 医学 Q1 MEDICINE, GENERAL & INTERNAL
American family physician Pub Date : 2024-08-01
Erin F Morcomb, Carmen M Dargel, Sydney A Anderson
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引用次数: 0

摘要

乳腺炎是一系列炎症的总称。哺乳期乳腺炎最常见,在美国的发病率约为 10%,通常发生在产后头 3 个月。临床诊断主要依据发热、乏力、局灶性乳房触痛、上覆皮肤红斑或色素沉着等症状,无需进行实验室检查或影像学检查。不过,应考虑进行乳汁培养以指导抗生素治疗,对于免疫力低下的患者或症状恶化或反复发作的患者,应进行超声波检查以确定脓肿。由于大多数乳腺炎是由炎症而非真正的感染引起的,因此通常只需采取 1 到 2 天的保守治疗措施(即非甾体抗炎药、冰敷、直接用乳房喂养婴儿和尽量减少吸奶)即可。如果症状没有改善,可以使用窄谱抗生素来治疗常见的皮肤菌群(如葡萄球菌、链球菌)。大多数患者可在门诊接受口服抗生素治疗;但如果病情恶化或有败血症的可能,则需要静脉注射抗生素和住院治疗。使用益生菌进行治疗或预防没有充分的证据支持。增加乳腺炎风险的因素包括过度刺激乳汁分泌和积极的乳房按摩造成的组织创伤;因此,不再建议频繁过度喂奶、过度抽吸乳汁以排空乳房、热敷和乳房按摩,因为这些做法可能会使病情恶化。最好的预防方法是掌握正确的哺乳技巧,包括良好的婴儿吮吸,并尽可能鼓励生理性母乳喂养,而不是吸奶。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Mastitis: Rapid Evidence Review.

Mastitis represents a spectrum of inflammatory conditions. Lactational mastitis is the most common, with an approximate incidence of 10% in the United States, and it usually occurs in the first 3 months postpartum. Diagnosis is made clinically based on the presence of symptoms such as fever, malaise, focal breast tenderness, and overlying skin erythema or hyperpigmentation without the need for laboratory tests or imaging. However, obtaining milk cultures should be considered to guide antibiotic therapy, and ultrasonography should be performed to identify abscesses in immuno-compromised patients or those with worsening or recurrent symptoms. Because most cases of mastitis are caused by inflammation and not a true infection, a 1- to 2-day trial of conservative measures (i.e., nonsteroidal anti-inflammatory drugs, ice application, feeding the infant directly from the breast, and minimizing pumping) is often sufficient for treatment. If there is no improvement in symptoms, narrow-spectrum antibiotics may be prescribed to cover common skin flora (e.g., Staphylococcus, Streptococcus). Most patients can be treated as outpatients with oral antibiotics; however, if the condition worsens or there is a concern for sepsis, intravenous antibiotics and hospital admission may be required. Use of probiotics for treatment or prevention is not supported by good evidence. Factors that increase the risk of mastitis include overstimulation of milk production and tissue trauma from aggressive breast massage; therefore, frequent overfeeding, excessive pumping to empty the breast, heat application, and breast massage are no longer recommended because they may worsen the condition. The best prevention is a proper lactation technique, including a good infant latch, and encouraging physiologic breastfeeding rather than pumping, if possible.

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来源期刊
American family physician
American family physician 医学-医学:内科
CiteScore
2.80
自引率
2.50%
发文量
368
审稿时长
4-8 weeks
期刊介绍: American Family Physician is a semimonthly, editorially independent, peer-reviewed journal of the American Academy of Family Physicians. AFP’s chief objective is to provide high-quality continuing medical education for more than 190,000 family physicians and other primary care clinicians. The editors prefer original articles from experienced clinicians who write succinct, evidence-based, authoritative clinical reviews that will assist family physicians in patient care. AFP considers only manuscripts that are original, have not been published previously, and are not under consideration for publication elsewhere. Articles that demonstrate a family medicine perspective on and approach to a common clinical condition are particularly desirable.
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