糖尿病肾病合并起搏器感染、胸骨后脓肿及感染性心内膜炎1例

摘要

糖尿病伴多器官并发症的诊治复杂,同时合并心血管疾病、肾脏病及起搏器感染等更为困难.本文报道1例患有糖尿病肾病、肾功能不全、陈旧性心肌梗死、糖尿病足、脓毒血症、起搏器感染、胸骨后脓肿、骨髓炎和感染性心内膜炎的病例,经肾脏替代治疗(RRT)、足部清创换药、拔除起搏器和足疗程抗生素后治疗病情好转.本病例的诊治提示我们糖尿病肾功能衰竭合并起搏器感染患者要及时拔除起搏器并应用足量敏感抗生素,早期RRT或可使患者获益.%It is quite complicated to diagnose and treat diabetes mellitus with multiple organ complications, especially in the cases complicated with cardiovascular disease, nephropathy and infection of pacemaker.Here we reported a patient suffering from diabetic nephropathy, but presenting with renal insufficiency, prior myocardial infarction, diabetic foot, further developed sepsis, pacemaker infection, substernal abscess, osteomyelitis and infective endocarditis as well.His condition turned stable after renal replacement therapy, debridement and dressing in his feet, removing pacemaker and full course of antibiotics.The diagnosis and treatment of the case remind us that for the diabetic nephropathy patients complicated with pacemaker infection, it is important to remove the pacemaker in time and prescript full course of antibiotics according to the results of antibiotic sensitivity test.Early renal replacement therapy may be beneficial to the prognosis of such cases.