【摘要】：目的通過(guò)分析糖尿病和非糖尿病患者在頜面部間隙感染的臨床特點(diǎn),探討糖尿病患者常見(jiàn)致病菌及藥敏分析,從而指導(dǎo)臨床用藥。方法研究對(duì)象選自青島大學(xué)附屬青島市立醫(yī)院口腔頜面外科2014年12月至2016年12月期間,收治的61例診斷為口腔頜面部間隙感染并行膿腫切開(kāi)引流的住院患者,并根據(jù)有無(wú)糖尿病分為糖尿病組和非糖尿病組。分別比較兩組患者的年齡、性別、感染來(lái)源、病原菌、抗菌藥物敏感性、空腹血糖水平、血白細(xì)胞總數(shù)和中性粒細(xì)胞百分比、住院天數(shù)。采用SPSS.19.0軟件包對(duì)計(jì)量資料行t檢驗(yàn),計(jì)數(shù)資料行χ2檢驗(yàn),以P㩳0.05有統(tǒng)計(jì)學(xué)差異。結(jié)果1.糖尿病組26例,男17例,女9例;非糖尿病組35例,男21例,女14例。糖尿病組占該研究資料的42.6%,兩組性別無(wú)明顯差異(χ2檢驗(yàn),P=0.184)。2.糖尿病組平均年齡(57.25±18.76)歲,顯著高于非糖尿病組(33.41±26.45)歲(t檢驗(yàn),P㩳0.001)。3.糖尿病組平均空腹血糖濃度(10.32±2.81)mmol/L,顯著高于非糖尿病組(4.94±0.54)mmol/L(t檢驗(yàn),P㩳0.01)。糖尿病組次晨空腹血平均白細(xì)胞計(jì)數(shù)(15.78±5.59)×109/L,與非糖尿病組(15.43±5.59)×109/L無(wú)明顯差異(t檢驗(yàn),P=0.852)。糖尿病組次晨空腹血平均中性粒細(xì)胞百分比(83.99±9.86)%,顯著高于非糖尿病組(72.87±16.26)%(t檢驗(yàn),P=0.003)。4.兩組患者中牙源性感染均為其最常見(jiàn)的感染來(lái)源,其最易累及的間隙均為下頜下間隙,其次為頦下間隙及咬肌間隙,最常檢出的病原菌均為鏈球菌,分別占比57.69%、60.00%,其次為葡萄球菌屬,此外,糖尿病組肺炎克雷伯菌的檢出率明顯高于非糖尿病組。5.兩組常見(jiàn)的致病菌對(duì)萬(wàn)古霉素100%敏感,而對(duì)左氧氟沙星、頭孢噻肟的敏感性也較高。6.糖尿病組住院天數(shù)(11.12±5.62)天,明顯高于非糖尿病組(7.77±2.83)天(t檢驗(yàn),P=0.009)。結(jié)論糖尿病頜面部間隙感染患者,在未取得細(xì)菌培養(yǎng)及藥敏試驗(yàn)結(jié)果之前,可以常規(guī)使用左氧氟沙星及頭孢噻肟,并根據(jù)口腔頜面部的感染特點(diǎn),聯(lián)合使用抗厭氧菌藥物,如替硝唑等,最終依據(jù)藥敏結(jié)果用藥。
[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 鹵18.76) years, which was significantly higher than that of non-diabetic group (33.41 鹵26.45) years (t test P0. 001). The mean fasting blood glucose concentration in diabetic group (10.32 鹵2.81) mmol / L was significantly higher than that in non-diabetic group (4.94 鹵0.54) mmol/L (t test P0.01). The mean fasting white blood cell count was (15.78 鹵5.59) 脳 10 9 / L in diabetic group and (15.43 鹵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 鹵9.86) was significantly higher than that in the non-diabetic group (72.87 鹵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 鹵5.62) days was significantly higher than that in non-diabetic group (7.77 鹵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.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R587.2

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