糖尿病患者颌面部间隙感染临床及细菌学分析（附11例临床病例汇报）

发布时间：2018-08-16 07:26

【摘要】：目的通过分析糖尿病和非糖尿病患者在颌面部间隙感染的临床特点,探讨糖尿病患者常见致病菌及药敏分析,从而指导临床用药。方法研究对象选自青岛大学附属青岛市立医院口腔颌面外科2014年12月至2016年12月期间,收治的61例诊断为口腔颌面部间隙感染并行脓肿切开引流的住院患者,并根据有无糖尿病分为糖尿病组和非糖尿病组。分别比较两组患者的年龄、性别、感染来源、病原菌、抗菌药物敏感性、空腹血糖水平、血白细胞总数和中性粒细胞百分比、住院天数。采用SPSS.19.0软件包对计量资料行t检验,计数资料行χ2检验,以P㩳0.05有统计学差异。结果1.糖尿病组26例,男17例,女9例;非糖尿病组35例,男21例,女14例。糖尿病组占该研究资料的42.6%,两组性别无明显差异(χ2检验,P=0.184)。2.糖尿病组平均年龄(57.25±18.76)岁,显著高于非糖尿病组(33.41±26.45)岁(t检验,P㩳0.001)。3.糖尿病组平均空腹血糖浓度(10.32±2.81)mmol/L,显著高于非糖尿病组(4.94±0.54)mmol/L(t检验,P㩳0.01)。糖尿病组次晨空腹血平均白细胞计数(15.78±5.59)×109/L,与非糖尿病组(15.43±5.59)×109/L无明显差异(t检验,P=0.852)。糖尿病组次晨空腹血平均中性粒细胞百分比(83.99±9.86)%,显著高于非糖尿病组(72.87±16.26)%(t检验,P=0.003)。4.两组患者中牙源性感染均为其最常见的感染来源,其最易累及的间隙均为下颌下间隙,其次为颏下间隙及咬肌间隙,最常检出的病原菌均为链球菌,分别占比57.69%、60.00%,其次为葡萄球菌属,此外,糖尿病组肺炎克雷伯菌的检出率明显高于非糖尿病组。5.两组常见的致病菌对万古霉素100%敏感,而对左氧氟沙星、头孢噻肟的敏感性也较高。6.糖尿病组住院天数(11.12±5.62)天,明显高于非糖尿病组(7.77±2.83)天(t检验,P=0.009)。结论糖尿病颌面部间隙感染患者,在未取得细菌培养及药敏试验结果之前,可以常规使用左氧氟沙星及头孢噻肟,并根据口腔颌面部的感染特点,联合使用抗厌氧菌药物,如替硝唑等,最终依据药敏结果用药。
[Abstract]:Objective to analyze the clinical characteristics of infection in maxillofacial space between diabetic and non-diabetic patients and to explore the common pathogenic bacteria and drug sensitivity analysis in diabetic patients so as to guide the clinical use of drugs. Methods from December 2014 to December 2016, 61 patients diagnosed as oral and maxillofacial space infection with incision and drainage were selected from Qingdao Municipal Hospital affiliated to Qingdao University. The patients were divided into diabetic group and non-diabetic group according to the presence or absence of diabetes. Age, sex, source of infection, pathogenic bacteria, antimicrobial susceptibility, fasting blood glucose level, total white blood cell count and percentage of neutrophils, length of stay were compared between the two groups. SPSS.19.0 software package was used to measure data line t test, count data bank 蠂 2 test, there was statistical difference in P0. 05. Result 1. There were 26 diabetic patients (17 males, 9 females) and 35 non-diabetic patients (21 males and 14 females). The diabetic group accounted for 42.6% of the data in the study. There was no significant difference between the two groups (蠂 2 test: P = 0.184) .2. The average age of diabetic group was (57.25 卤18.76) years, which was significantly higher than that of non-diabetic group (33.41 卤26.45) years (t test P0. 001). The mean fasting blood glucose concentration in diabetic group (10.32 卤2.81) mmol / L was significantly higher than that in non-diabetic group (4.94 卤0.54) mmol/L (t test P0.01). The mean fasting white blood cell count was (15.78 卤5.59) 脳 10 9 / L in diabetic group and (15.43 卤5.59) 脳 10 9 / L in non-diabetic group (t test, P < 0. 852). The average percentage of neutrophils in fasting blood in the diabetic group (83.99 卤9.86) was significantly higher than that in the non-diabetic group (72.87 卤16.26)% (t test 0.003) .4. In both groups, odontogenic infection was the most common source of infection. The most easily involved space was submandibular space, followed by submental space and masseter space. Streptococcus was the most frequently detected pathogen. In addition, the detection rate of Klebsiella pneumoniae in diabetes group was significantly higher than that in non-diabetic group. The two groups were sensitive to vancomycin 100%, and to levofloxacin, cefotaxime. The days of hospitalization in diabetic group (11.12 卤5.62) days was significantly higher than that in non-diabetic group (7.77 卤2.83) days (t test P 0.009). Conclusion Levofloxacin and cefotaxime can be routinely used in diabetic patients with maxillofacial space infection before the results of bacterial culture and drug sensitivity tests are obtained. Such as tinidazole and so on, the final drug based on drug sensitivity.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R587.2

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