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目的探讨细菌感染对糖尿病足患者下肢血管病情的影响。方法收集2015年6月-2016年8月于医院住院治疗的糖尿病足伴细菌感染患者88例,依据泛大西洋学会联盟(TASC)分级(A~D)将患者分为A组24例、B组25例、C组20例、D组19例。比较四组患者间一般资料和实验室检查指标如踝肱指数(ABI)、趾肱指数(TBI)、白细胞计数等;收集患者足部溃疡分泌物做细菌培养和药敏实验。结果从A组到D组,患者年龄、病程、中性粒细胞比例逐渐增加(P<0.05),ABI和TBI逐渐降低(P<0.05),重度感染比例、混合感染比例逐渐上升(P<0.05);细菌培养共检出病原菌195株,其中革兰阴性菌102株占52.31%,革兰阳性菌79株占40.51%,真菌14株占7.18%;药敏结果显示,主要革兰阴性菌对阿米卡星、亚胺培南等抗菌药物较敏感,主要革兰阳性菌均对达福普丁和万古霉素等较敏感。结论糖尿病足患者下肢感染与血管病变明显相关,随着下肢血管病变发展,混合感染比例随之升高,感染程度也越来越严重,建议使用敏感抗菌药物进行抗感染治疗。
Objective To investigate the effect of bacterial infection on the vascular condition of lower extremities in patients with diabetic foot. Methods Eighty-eight patients with diabetic foot infections were hospitalized in our hospital from June 2015 to August 2016. According to the Pan-Atlantic Association (TASC) classification (A ~ D), patients were divided into group A (24 cases), group B 25 cases, C group 20 cases, D group 19 cases. General data and laboratory tests such as ankle-brachial index (ABI), toe-brachial index (TBI) and white blood cell count were compared between the four groups. Bacterial culture and drug susceptibility tests were performed on patients with foot ulcer secretions. Results From group A to group D, the age, course of disease and neutrophil proportion gradually increased (P <0.05), ABI and TBI decreased (P <0.05), the proportion of severe infection and mixed infection increased gradually (P <0.05 ); Bacteria were detected in 195 strains of pathogens, of which 102 strains of gram-negative bacteria accounted for 52.31%, 79 strains of gram-positive bacteria accounted for 40.51%, fungi 14 strains accounted for 7.18%; drug susceptibility results show that the main gram-negative bacteria Amikacin, imipenem and other antibacterial drugs are more sensitive to the main Gram-positive bacteria are more susceptible to daphnettin and vancomycin. Conclusion The lower extremity infection in diabetic foot patients is obviously related to the vascular disease. With the development of lower extremity vascular disease, the proportion of mixed infection increases with the degree of infection becoming more and more serious. It is suggested that antimicrobial agents be used for anti-infective therapy.