不规范注射胰岛素致严重皮下软组织感染一例

摘要

2018年1月1日,笔者单位收治了1例右大腿皮下软组织感染的44岁男性糖尿病患者.该例患者多次使用同一针头在未经消毒的右大腿皮下注射胰岛素,且血糖长期控制不佳,劳累后出现严重皮下软组织感染,发病时伴发酮症酸中毒,于当地医院保守治疗约1个月,感染仍持续存在.转至笔者单位后,结合患者之前实验室检查指标及局部B超检查结果,笔者高度怀疑坏死性筋膜炎的诊断,建议患者进一步手术治疗,但患者明确拒绝,因此继续予抗感染及支持治疗.治疗1个月后患者基本痊愈,出院2个月后随访患者恢复良好.本病例提示规范注射胰岛素以及早期诊断严重皮下软组织感染的重要性.%On January 1st 2018,a male 44 years old diabetic patient with subcutaneous soft tissue infection in right thigh was admitted to our hospital.The patient repeatedly used the same needle to inject insulin subcutaneously in the unsterilized right thigh,and his blood glucose was badly controlled in the long term.Severe subcutaneous soft tissue infection of the right thigh occurred after his fatigue,accompanied with ketoacidosis.Then he received conservative treatment in the local hospital for one month,but the infection persisted.After being transferred to our hospital,we highly suspected the diagnosis of necrotizing fasciitis according to previous test indicators and local B-ultrasound results,but suggestion of aggressive surgery was refused.So we treated him with conservative therapies using sensitive antibiotics and supportive remedies.The patient was basically healed after treatment of 1 month and he was recovered well during the follow-up 2 months after discharged from our hospital.This case emphasizes the importance of standard injection of insulin and early diagnosis of severe subcutaneous soft tissue infection.