362例糖尿病足感染患者的临床特点调查分析

目的 调查分析糖尿病足感染(diabetic foot infection,DFI)患者的临床特点,为临床有效防控DFI提供参考依据.方法 回顾性分析恩施州中心医院2018年1月至2020年12月收治住院的362例DFI患者的病例资料,按糖尿病足Wagner分级标准将研究对象分为轻型DFI组和重型DFI组,其中轻型DF...     

糖尿病足89例临床资料分析

目的研究糖尿病足患者的诱因、治疗方法、治疗周期,提高治疗效果,降低糖尿病足的致残率、死亡率及危害。方法选择糖尿病足患者89例,采集患者的详细临床资料,根据患者的病情给予相关检查及治疗,治疗结束后进行回顾性分析。结果89例患者,因烧烫伤导致者26例,鞋子不适者21例,锐器刺伤者18例,脚气感染不愈合所致者15例,其他9例。治疗时间最短4周,最长16周。痊愈71例,截肢11例,死亡2例,转院5例。结论糖尿病足治疗周期长,费用昂贵,致残率高,严重影响患者的生存质量和寿命,危害严重。应该引起社会的高度重视,并给予积极的预防和治疗。     

老年患者泌尿系感染的临床特点和危险因素分析

目的调查分析老年患者泌尿系感染的临床特征和相关危险因素,并制定相应的干预对策。方法选择2010年1月至2012年12月本院泌尿外科收治的87例并发泌尿系感染的老年患者,进行回顾性调查分析。结果87例患者以尿频、尿痛、血尿及排尿困难为主要临床表现,其中≥60岁者发生率为83.91%（73/87）,合并糖尿病、脑血管疾患等基础疾病者为78.16%（68/87）,实施侵袭性操作者占67.81%（59/87）。结论老年患者继发泌尿系感染与高龄、合并基础疾病、侵袭性操作等因素密切相关,应给予高度重视。     

糖尿病足的临床治疗体会

目的 探讨糖尿病足的治疗方法,提高糖尿病足的诊治水平,降低病死率及致残率.方法 30例糖尿病足患者给予糖尿病饮食,严格控制血糖,全身应用扩血管改善微循环药物及抗生素,局部清创换药手术植皮的综合治疗,并分析其临床疗效,总结治疗方法.结果 30例患者经系统治疗后,痊愈28例(93.3%),好转1例(3.3%),截肢1例(3.3%).结论 糖尿病足病情复杂,结合降糖、改善微循环、抗感染、局部创面清创换药处理(皮肤缺损大者手术植皮)为一体进行综合治疗有较好的疗效.     

丹毒住院患者156例临床特点和危险因素分析

丹毒,又称急性网状淋巴管炎,是皮肤和黏膜网状淋巴管的急性炎症感染,主要由A群β-溶血性链球菌侵袭所致,好发于下肢和面部.导致丹毒的发病原因很多,如手足癣、静脉炎、虫咬皮疹和皮肤破溃等,南方地区的丝虫病也可诱发丹毒,多见于炎夏暑湿季节,且多发于成年人[1],其主要表现为境界清楚的局限性红肿热痛,与正常组织有明显的分界线,具有炎症蔓延迅速、治疗困难和极易复发等临床特点,病情严重者可出现化脓性淋巴管炎、脓毒血症及败血症等并发症,严重危害患者的生命健康,若给予适当的处理其病死率可降低至1%以下[2].     

系统性红斑狼疮患者感染临床特点及危险因素分析

目的:回顾性分析系统性红斑狼疮(SLE)并发感染患者的感染特点及危险因素。方法:选取2006年1月～2010年12月在我院住院的SLE患者81例,收集临床及实验室资料,临床资料主要包括患者性别、年龄、糖皮质激素用量、疗程,环磷酰胺等免疫抑制剂使用、感染情况等。实验室指标有血常规、血沉、超敏C反应蛋白、血脂(三酰甘油、胆固醇)、血白蛋白、病原学结果等,观察感染部位、病原菌特点及各因素对SLE感染发生率变化的影响。结果:(1)大部分感染以细菌为主,占53.4%,同时以肺炎克雷伯氏菌为主的G-菌占绝大多数;真菌以念珠菌属最常见,且多见于50岁以上SLE患者;巨细胞病毒感染是SLE感染患者主要的病毒检出类型。(2)SLE以呼吸道感染占绝大多数,其次尿路感染在SLE患者也不少见,带状疱疹是最常见的皮肤感染表现。(3)与SLE非感染患者比较,老年患者、CRP增高、血白蛋白下降者感染发生率明显升高,差异有统计学意义。其中>50岁SLE患者感染危险度是年轻患者的6.44倍,血白蛋白下降患者感染风险较正常增加1倍。而性别、ESR、血脂等因素改变与感染无明显相关性。结论:贫血对感染的发生率改变无明显影响。CRP增高与SLE的活动状态无明显关系。     

175例淀粉样变性患者临床特点及预后分析

淀粉样变性是一类系统性疾病,由"罕见"变"常见"需引起重视。本研究回顾分析本中心近20年来175例淀粉样变性患者的临床资料,总体评估患者资料,探讨相关影响因素,以期提高早期确诊率,改善患者预后。研究结果显示,该病好发年龄为50~59岁（占34.85%）,且年龄越大治疗效果越差（ OR=1.064,95% ...     

重症急性胰腺炎继发胰腺感染的危险因素和感染特点分析

目的分析重症急性胰腺炎继发胰腺感染的危险因素和感染特点。方法选择2013-08—2015-09间收治的58例重症急性胰腺炎患者,给予腹腔穿刺及细菌培养,按有无感染标准将其分为观察组(感染,n=19例)与对照组(未感染,n=39例)。观察2组患者入院时急性生理学及慢性健康状况评分Ⅱ(APACHEⅡ)、胆源性或非胆源性致病因素、中心静脉留置导管时间、胃肠道障碍水平、血淀粉酶水平、血清清蛋白水平、血糖,CT表现、有无低氧血症、机械通气等因素。结果 2组患者中心静脉留置导管时间、禁食时间、胃肠道功能障碍时间、低氧血症发生情况等比较,差异有统计学意义(P0.05)。APACEⅡ、血淀粉酶水平、血糖水平比较,差异无统计学意义(P0.05)。2组患者的胆源性因素、CT表现有无坏死、渗出及是否机械通气等例数比较,差异无统计学意义(P0.05)。本组19例感染患者共分离出菌株23株,依次为阴沟肠杆菌、铜绿假单胞菌、金黄色葡萄球菌。结论重症急性胰腺炎继发胰腺感染与中心静脉留置导管时间、禁食时间、胃肠道功能障碍时间、低氧血症等因素有关。革兰阴性菌是主要的病原菌。给予个体化针对性治疗,适当应用抗菌药物,及时预防胰腺感染,可提高治疗有效性,改善预后。     

老年人胆系感染263例临床特点分析

老年人机体生理储备下降,免疫功能减弱,全身细胞呈退行性变化,许多器官具有潜在的功能不全,且有较多的伴随疾病,致老年胆系感染的过程更为复杂和严重.现将我院近5年间60岁以上的老年胆系感染263例为疾病组,设同期非老年胆系感染254例为疾病对照组,通过对两组临床资料的分析比较,以探讨老年胆系感染的临床特点.     

结缔组织病相关性间质性肺病合并肺感染的临床表现特点及感染相关因素分析

目的:探讨结缔组织病相关性间质性肺病(CTD-ILD)合并肺感染患者的临床表现特征,并分析其感染相关因素。方法:回顾性分析福州肺科医院呼吸内科2018年8月—2020年10月收治的152例CTD-ILD住院患者的临床资料,比较91例合并肺感染(感染组)患者和61例未合并肺感染(非感染组)患者的一般情况、临床表现、相关实验室检查等指标的差异,利用Logistic多元回归方法分析肺感染的独立影响因素。结果:CTD-ILD合并肺感染患者呼吸道相关临床表现与非感染组之间差异有显著的统计学意义(P <0.05),感染组患者多有发热、咳嗽、咳痰、胸闷、气喘、肺部干性或湿性啰音等表现;感染组血白细胞、C反应蛋白、红细胞沉降率、中性粒细胞百分比升高(P <0.05),血清白蛋白水平和动脉血氧分压明显低于非感染组(P <0.05);感染组高分辨率CT支气管扩张表现重于非感染组(P <0.05)。多因素分析结果显示,C反应蛋白≥28.45 mg/L、血清白蛋白降低、支气管扩张的高分辨率CT表现是CTD-ILD合并肺感染的独立危险因素(P <0.05)。结论:CTD-ILD合并...     

踝肱指数与糖尿病足细菌感染的相关性分析

目的:分析糖尿病足(DF)细菌感染类型与踝肱指数(ABI)的关系,为临床针对性选择抗菌药物治疗提供参考。方法:收集2018 年1 月—2019 年1 月东直门医院周围血管科收治的189 例患者,记录踝肱指数(ABI),根据TASC 分级分为4 组,正常ABI 组(0.9 ＜ ABI ≤ 1.3),轻度ABI 组(0.7 ＜ ABI ≤ 0.9),中度ABI 组(0.4 ＜ ABI ≤ 0.7),重度ABI 组(ABI ≤ 0.4),分析四组患者的DF 细菌谱特征及对应抗生素敏感程度。结果:189 例患者中共培养出212 株细菌,有23 例混合细菌感染,革兰阴性菌126 株(59.43%),革兰阳性菌82 株(36.68%)。四组中以革兰阴性菌为主要致病菌。轻度ABI 组、中度ABI 组中DF 细菌感染程度加重(P <0.05)。Spearman 相关系数为-0.707,说明DF 细菌感染程度与ABI 呈负相关(P ＜ 0.05)。分析四组革兰阳性菌感染类型,随着ABI 指数降低,金色葡萄球菌、粪肠球菌在各组感染比例增多(P <0.05);分析四组革兰阴性菌感染类型,绿脓假单胞菌在感染比例最高(44.0%),其次感染细菌为阴沟肠杆菌(14.29%)。正常ABI 组、轻度ABI 组、中度ABI 组中主要致病菌为表皮葡萄球菌和金色葡萄球菌,敏感抗生素主要为利奈唑胺、万古霉素,重度ABI 组主要致病菌为粪肠球菌,敏感抗生素主要为万古霉素、氨苄西林。正常ABI 组、轻度ABI 组、中度ABI 组主要致病菌为绿脓假单胞菌,敏感抗生素主要是阿米卡星、环丙沙星等;重度ABI 组主要致病菌为阴沟肠杆菌,敏感抗生素主要为喹诺酮类、头孢四代、碳靑霉烯类等。结论:随着ABI 的降低,下肢缺血程度加重,DF 感染风险增加,其细菌谱主要特点是革兰阴性菌﹥革兰阳性菌﹥真菌,临床要针对药敏实验结果及时调整抗生素,降低DF 感染的概率。     

周围神经松解术在降低糖尿病足部溃疡发病率中的应用

糖尿病足部溃疡的发生与下肢周围神经病变密切相关。周围神经松解术通过对病变神经的局部受压点进行松解,来治疗糖尿病周围神经病变,该手术不仅改善周围神经病变引发的症状,且极大降低了足部溃疡的发生率。本文就周围神经松解术降低糖尿病下肢周围神经病变患者足部溃疡发病率的基础和临床研究进行综述。     

Foot complications in patients with diabetes

Foot complications are a common cause of hospital admission of people with diabetes and a frequent cause of amputation. Neuropathy and arterial disease make the foot particularly vulnerable, but infection is often the pathology precipitating presentation. Recognition of the patient at risk may prevent the development of foot complications, but if they do occur urgent treatment is required to prevent limb loss. The infected foot in a patient with diabetes is a surgical emergency. In addition to antibiotics, debridement and surgical drainage of infection should be considered within the first 24 hours. Once the foot is made safe, revascularization should be undertaken in those with significant arterial disease. Adoption of a multidisciplinary team approach to managing diabetic foot complications has resulted in reduction in major amputations in some European countries.     

Foot complications in patients with diabetes

Foot complications are a common cause of hospital admission of people with diabetes and a frequent cause of amputation. Neuropathy and arterial disease make the foot particularly vulnerable, but infection is often the pathology precipitating presentation. Recognition of the patient at risk may prevent the development of foot complications, but if they do occur urgent treatment is required to prevent limb loss. The infected foot in a patient with diabetes is a surgical emergency. In addition to antibiotics, debridement and surgical drainage of infection should be considered within the first 24 hours. Once the foot is made safe, revascularization should be undertaken in those with significant arterial disease. Adoption of a multidisciplinary team approach to managing diabetic foot complications has resulted in reduction in major amputations in some European countries.     

Foot complications in patients with diabetes

Foot complications are a common cause of hospital admission of patients with diabetes and a frequent cause of amputation. Neuropathy and arterial disease make the foot particularly vulnerable, but infection is often the final presenting complication. Recognition of the patient at risk may prevent the development of foot complications initially, but if they occur rapid treatment is required to prevent limb loss. The infected foot in a patient with diabetes is a surgical emergency. In addition to antibiotics, debridement and surgical drainage of infection should be considered within the first 24 hours. Once the foot is made safe revascularization should be undertaken in those with significant arterial disease. Adoption of a coordinated approach to managing diabetic foot complications has resulted in reduction in major amputation in some European countries.     

Foot complications in patients with diabetes

Foot complications are a common cause of hospital admission of patients with diabetes and a frequent cause of amputation. Neuropathy and arterial disease make the foot particularly vulnerable, but infection is often the final presenting complication. Recognition of the patient at risk may prevent the development of foot complications initially, but if they occur urgent treatment is required to prevent limb loss. The infected foot in a patient with diabetes is a surgical emergency. In addition to antibiotics, debridement and surgical drainage of infection should be considered within the first 24 hours. Once the foot is made safe, revascularization should be undertaken in those with significant arterial disease. Adoption of a multidisciplinary team approach to managing diabetic foot complications has resulted in reduction in major amputation in some European countries.     

Foot complications in patients with diabetes

Foot complications are a common cause of hospital admission of patients with diabetes and a frequent cause of amputation. Neuropathy and arterial disease make the foot particularly vulnerable, but infection is often the final presenting complication. Recognition of the patient at risk may prevent the development of foot complications initially, but if they occur urgent treatment is required to prevent limb loss. The infected foot in a patient with diabetes is a surgical emergency. In addition to antibiotics, debridement and surgical drainage of infection should be considered within the first 24 hours. Once the foot is made safe revascularization should be undertaken in those with significant arterial disease. Adoption of a multidisciplinary team approach to managing diabetic foot complications has resulted in reduction in major amputation in some European countries.     

Foot complications in people with diabetes

Foot complications are the most common cause of hospital admission of people with diabetes and a frequent cause of amputation. Neuropathy and peripheral arterial disease make the foot particularly vulnerable to ulceration, but infection is often the pathology precipitating presentation. Recognition of the patient at risk of ulceration may allow interventions to prevent the development of foot complications. When complications do occur, urgent treatment is required to prevent limb loss; the infected foot in a patient with diabetes is a surgical emergency. In addition to antibiotics, debridement and surgical drainage of infection should be considered within the first 24 hours after presentation. Once the foot is made safe, revascularization should be undertaken in those with significant arterial disease. Adoption of a multidisciplinary team approach to managing diabetic foot complications has resulted in reduction in major amputations in some European countries.     

2型糖尿病住院患者糖尿病肾脏疾病的发生率及危险因素分析

目的：分析2型糖尿病住院患者的糖尿病肾脏疾病（DKD）的发生率及危险因素,为临床糖尿病肾脏疾病的防治工作提供理论依据。方法：对2008年1月～2010年8月在上海交通大学附属第六人民医院内分泌代谢科住院的2型糖尿病患者测定血糖、肾功能、血脂谱、24h尿白蛋白等。应用简化肾脏病膳食改良试验（MDRD）公式计算肾小球滤过率（GFRMDRD）。所有患者均由眼科医生进行眼底摄片。按2007年美国肾脏病基金会（NKF）的糖尿病和慢性肾脏疾病的临床诊断治疗指南,将研究人群分为正常组（NCKD）、非糖尿病性肾脏疾病（NDRD）组及DKD组。结果：（1）共入选患者2225例,男1184例,女1041例;平均年龄为（60.5±11.7）岁。本研究人群中,DKD的发生率为15.4%,NDRD的发生率为18.5%。（2）DKD组患者的年龄、糖尿病病程、收缩压、血肌酐、总胆固醇（TC）、低密度胆固醇水平（LDL-C）、24h尿白蛋白量均显著高于NDRD组（P〈0.05）。（3）Logistic回归分析显示：糖尿病病程（OR=1.077,95%CI为1.059～1.096,P〈0.01）、收缩压（OR=1.039,95%CI为1.032～1.047,P〈0.01）、糖化血红蛋白（OR=1.092,95%CI为1.032～1.156,P〈0.01）、TC（OR=1.171,95%CI为1.050～1.306,P〈0.01）、HDL-C（OR=0.558,95%CI为0.369～0.844,P〈0.01）是DKD发生的独立危险因素。结论：为有效地延缓2型糖尿病肾脏病变的发生及发展,临床工作中要严格控制血压、血糖、血脂。