糖尿病患者医院获得性肺炎临床特征及病原学分析

摘要

探讨糖尿病合并医院获得性肺炎(HAP)患者的临床特征及病原学，为其防治提供参考。对98例2型糖尿病合并HAP的临床表现、实验室检查、X线表现、病原菌、治疗及预后情况进行回顾性分析。2型糖尿病患者合并HAP的首发症状以发热为主(83.7%)，其次为咳嗽、咳痰(16.3%)。28.6%患者病程中伴消化系统症状，出现多脏器功能不全6例(6.1%)。实验室检查发现，79.6%患者出现白细胞总数升高，18.4%出现血红蛋白降低，12.2%出现血小板降低；与HAP发病前比较，空腹及餐后2 h血糖明显升高者占87.8%，ALT或AST升高占63.3%，白蛋白降低占59.2%，BUN或Cr升高占38.3%。胸部X线检查发现单一病灶36例(36.7%)，多发病灶62例(63.3%)，其中累及2个肺叶以上者38例(38.8%)，合并胸腔积液者28例(28.6%)。病原菌以G-菌(59.2%)为主，主要为肺炎克雷伯杆菌(28.6%)和铜绿假单胞菌(12.2%)；G+菌占26.5%，以金黄色葡萄球菌(10.2%)为主；真菌占14.3%。平均每例使用抗生素2.26种，疗程平均(12.6依5.3) d。6例(6.1%)患者死亡。糖尿病患者并发HAP多以发热为首发症状，病原菌以G-菌为主，应在控制血糖的基础上，早期联合应用抗生素治疗。%To explore the clinical feature and etiology of the patients with diabetes complicated with hospital acquired pneumonia (HAP) and to provide a reference for prevention and treatment. A retrospective analysis was made on the clinical manifestations, lab examinations, X-ray features, pathogenic bacteria, operative and postoperative conditions of 98 patients with type-2 diabetes complicated with HAP. The fever was the main initial symptom of Type 2 diabetics complicated with HAP(83.7%), meanwhile cough and expectoration was secondary (16.3%). Gastrointestinal symptom occurred in 28.6%of the patients and multiple-organ defect occurred in 6 patients (6.1%). The lab examinations indicated that white blood cell sum in 79.6% of the patients increased, hemoglobin in 18.4%of ones decreased, and platelet in 12.2%of ones decreased. Compared with before the onset of HAP, the fasting and 2-hour postprandial plasma glucose in 87.8%of the patients increased significantly, ALT or AST in 63.3%of ones increased, albumin in 59.2% of ones decreased, and BUN or Cr in 38.3% of ones increased. According to the X-ray checks on chest, single lesion was found in 36 cases (38.8%) and multiple lesions were found in 62 ones (63.3%), among which 38 ones (38.8%) got more than two lung lobes implicated respectively and 29 ones (28.6%) were complicated with pleural effusion. Pathogenic bacteria were mainly G- bacteria (59.2%), including (28.6%) and (12.2%); G+ bacteria accounted for 26.5%, mainly including (10.2%);fungus accounted for 14.3%. On average, 2.26 antibiotics were applied for each patient and the average course of treatment was(12.6±5.3)d. Six patients(6.1%) died. The main initial symptom of the patients with diabetes complicated with HAP is fever and the main pathogenic bacteria are G-bacteria. These patients should be treated with early combined application of antibiotics on the basis of plasma glucose control.