老年2型糖尿病并发败血症患者的临床分析

目的 探讨老年2型糖尿病并发败血症患者的临床特点，以提高治疗水平。方法 对我院近13年来收治的58例老年2型糖尿病并发败血症患者的临床资料进行总结分析。结果 58例败血症患者致病菌入侵途径分别为：泌尿系统19例，呼吸系统17例，深静脉导管7例，胆管7例，破损皮肤1例，入侵途径未明7例。58例中，医院感染23例，占39．7％。血培养显示：肺炎克雷伯菌24例，大肠埃希菌16例，金黄色葡萄球菌10例，科氏葡萄球菌科氏亚种、表皮葡萄球菌、恶臭假单胞菌和光滑假丝酵母菌各2例。24例肺炎克雷伯菌败血症患者中，肝脓肿12例（50．0％），有肝内胆管积气现象15例（62．5％）。58例患者均用胰岛素强化降糖，其中56例细菌性败血症患者应用三代头孢和氟喹诺酮类抗生素；2例光滑假丝酵母菌败血症患者静脉应用氟康唑。死亡7例，病死率12．1％。结论 2型糖尿病并发败血症以革兰阴性菌败血症多见，其中肺炎克雷伯菌败血症常有迁移病灶形成肝脓肿和肝内胆管积气现象。深静脉穿刺留置导管与留置导尿是导致医院感染败血症危险的因素。强有力抗菌及病菌迁移病灶的处理非常重要，同时胰岛素强化降糖和对症支持治疗也是抢救成功的关键。

Clinical study on elderly patients with type 2 diabetes mellitus complicated by septicemia

Objective To investigate the clinical characteristics of septicemia in type 2 diabetes mellitus,to enhance prevention level and decrease death rate.Methods A retrospective study was carried out,the data were collected from 58 cases of type 2 diabetes mellitus complicated by septicemia in our hospital in the past 13 years.Results The pathogenic invasive pathways included:19 cases of urinary tract,17 cases of respiratory tract,7 cases of intravenous catheter detain,7 cases of biliary tract,1 case of skin breakage,and 7 cases of unclear origin.Twenty-three of 58 cases were from nosoeomial infection (39.7%),among which 10 cases of urethral detain,7 cases of intravenous catheter detain,and 6 cases of respiratory tract infection.Pathogenic distribution was as following:24 cases of klehsiella pneumoniae,16 cases of escherichia coli,10 cases of staph aureus,2 cases of staphylococcus cohnii cohnii,2 cases of staphylococcus epidermidis,2 cases of pseudomonas putida,2 cases of candida glabrata.Among the 24 cases of llehsiella pneumoniae,12 cases showed migrating hepatapostema (50.0%),and 15 showed pneumatosis phenomenon in the intrahepatie bile (62.5%).Two cases originated from fungal septicemia.Among 56 cases under antibacterial therapy 15 cases developed fungal septicemia (26.8%).Fifty-eight cases were treated with insulin for forcing down serum glucose,56 cases of bacterial septicemia were treated with the third generation cephalosporins and fluoroquinolones.Two cases of pseudomonas putida septicemia were treated with intravenous injection of fluconazole.Seven cases died (12.1%).Conclusions Gram-negative bacilli were the major pathogens of septicemia in type 2 diabetes mellitus.Migrating hepatapostema and pneumatosis phenomenon in the intrahepatic bile often showed klebsiella pneumoniae septicemia.The important risk factors for septicemia were intravenous catheter detain and urethral detain.Therefore,strictly aseptic operation and removing vessel detain in time is very important.It is key points to make an early diagnosis,have a strong antibiosis therapy and treat the migrating pathogenic focus.And it is important to intensify serum glucose monitoring and strengthen supportive treatment.