本文選題：糖尿病足　切入點(diǎn)：wagner分級　出處：《天津醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的了解糖尿病足患者的一般臨床情況和傷口分泌物細(xì)菌學(xué)特點(diǎn),包括年齡與性別分布、糖尿病病程、傷口特點(diǎn)、wagner分級、實(shí)驗(yàn)室指標(biāo)、下肢血管病變、菌群分布及耐藥等情況,分析糖尿病足患者創(chuàng)面感染的影響因素,為臨床有效防治感染、合理使用抗菌藥物提供參考。方法1、收集2013年1月-2016年12月期間天津市第一中心醫(yī)院整形與燒傷科收治的103例糖尿病足患者,統(tǒng)計分析患者的性別、年齡、體重指數(shù)、血壓、糖尿病病程、傷口特點(diǎn)(面積、深度及位置)、wagner分級、實(shí)驗(yàn)室指標(biāo)檢測、下肢血管檢查、細(xì)菌培養(yǎng)及藥敏結(jié)果等臨床資料。2、根據(jù)糖尿病足創(chuàng)面感染可能有關(guān)的因素,建立數(shù)據(jù)庫,分析創(chuàng)面感染的相關(guān)影響因素。3、采用SPSS21.0統(tǒng)計軟件對數(shù)據(jù)進(jìn)行分析,計數(shù)資料以率表示;計量資料以(?±s)表示,對不符合正態(tài)分布資料的兩個變量是否相關(guān)采用非參數(shù)法中的等級相關(guān)分析,相關(guān)程度大小用r表示,對可能的感染影響因素采用Logistic逐一分析,P0.05為差異有統(tǒng)計學(xué)意義。結(jié)果1、本組共收治糖尿病足患者103例,共采集標(biāo)本194例,有167例培養(yǎng)出病原菌,檢出率86.1%(167/194),共培養(yǎng)得到173株菌株,前4位病原菌為金黃色葡萄球菌17.9%(31/173)、銅綠假單胞菌14.5%(25/173)、表皮葡萄球菌11.6%(20/173)及鮑曼不動桿菌9.3%(16/173)。革蘭陽性菌78株,占45.1%(78/173);革蘭陰性菌92株,占53.2%(92/173);真菌3株,占1.7%(3/173)。革蘭陽性菌最常見的是金黃色葡萄球菌,占39.7%(31/78),其次為表皮葡萄球菌,占25.6%(20/78)。革蘭陰性菌最常見的銅綠假單胞菌,占27.2%(25/92),其次為鮑曼不動桿菌,占17.4%(16/92)。2、金黃色葡萄球菌對萬古霉素和利奈唑胺敏感率分別為100.0%(31/31)和83.9%(26/31);表皮葡萄球菌對萬古霉素和替加環(huán)素敏感率分別為100.0%(20/20)和85.0%(17/20)。銅綠假單胞菌對亞胺培南和美羅培南敏感率分別為72.0%(18/25)和84.0%(21/25);鮑曼不動桿菌對阿米卡星、亞胺培南及美羅培南敏感率分別為75.0%(12/16)、81.3%(13/16)及81.3%(13/16)。3、糖尿病足傷口感染可能的的影響因素Logistic回歸分析結(jié)果顯示,糖尿病足傷口感染的前5個影響因素分別是低蛋白血癥(OR=6.172,P=0.001)、下肢血管病變(OR=3.741,P=0.004)、合并糖尿病腎病(OR=2.685,P=0.002)、糖尿病病程(OR=2.324,P=0.004)及糖化血紅蛋白升高(OR=1.216,P=0.005)。結(jié)論1、103例糖尿病足患者傷口病原菌檢出率為86.08%,前4位病原菌為金黃色葡萄球菌、銅綠假單胞菌、表皮葡萄球菌及鮑曼不動桿菌,分別占17.9%、14.5%、11.6%及9.3%。革蘭陽性菌占45.1%,前2位病原菌為金黃色葡萄球菌39.7%和表皮葡萄球菌25.6%;革蘭陰性菌占53.2%,前2位為銅綠假單胞菌27.2%和鮑曼不動桿菌17.4%。2、金黃色葡萄球菌對萬古霉素和利奈唑胺敏感率分別為100.0%和83.9%;表皮葡萄球菌對萬古霉素和替加環(huán)素敏感率分別為100.0%和85.0%。銅綠假單胞菌對亞胺培南和美羅培南敏感率分別為72.0%和84.0%;鮑曼不動桿菌對阿米卡星、亞胺培南及美羅培南敏感率分別為75.0%、81.3%及81.3%。3、糖尿病足傷口感染的前5個影響因素根據(jù)相對危險度(OR)值的大小依次為低蛋白血癥(6.172)、下肢血管病變(3.741)、合并糖尿病腎病(2.685)、糖尿病病程(2.324)及糖化血紅蛋白升高(1.216)。
[Abstract]:Objective to understand the clinical situation of patients with diabetic foot wound secretion and bacteriological characteristics, including age and gender distribution, duration of diabetes, wound characteristics, Wagner classification, laboratory index, lower extremity vascular disease, bacterial distribution and drug-resistance analysis, factors affecting wound in patients with diabetic foot infection, for the effective prevention and treatment of infection, to provide a reasonable reference the use of antimicrobial drugs. Methods 1, from January 2013 -2016 year in December in Tianjin First Central Hospital of plastic and burn department treated 103 cases of patients with diabetic foot, statistical analysis of patients with gender, age, body mass index, blood pressure, diabetes duration, wound characteristics (size, depth and location), Wagner classification, laboratory test, examination of lower extremity vascular. Bacterial culture and drug sensitivity results and clinical information of.2, establish the database according to the factors related to diabetic foot wound infection of wound .3 infection related factors, the data were analyzed using SPSS21.0 statistical software, count data expressed as a ratio; measurement data to (? + s) said that the two variables do not conform to the normal distribution of data is related to the use of non parametric rank correlation analysis method, correlation degree by R, using Logistic one by one analysis of the possible impact factors of infection in P0.05, the difference was statistically significant. The results of the 1 groups were treated 103 cases of diabetic foot patients were collected in 194 cases, 167 cases of cultured pathogenic bacteria, the detection rate of 86.1% (167/194), 173 strains were cultured, the top 4 pathogens were Staphylococcus aureus (31/173 17.9%), Pseudomonas aeruginosa (25/173 14.5%), Staphylococcus epidermidis (20/173 11.6%) and Bauman Acinetobacter (16/173) 9.3%. 78 strains of gram positive bacteria accounted for 45.1% (78/173); 92 strains of gram negative bacteria accounted for 53.2% (92/173); 3 strains of fungi. 3/1 (accounting for 1.7% 73) leather. The most common gram positive cocci were Staphylococcus aureus, 39.7% (31/78), followed by Staphylococcus epidermidis, accounted for 25.6% (20/78). Pseudomonas aeruginosa is the most common gram negative bacilli, accounting for 27.2% (25/92), followed by Bauman Acinetobacter, accounting for 17.4% (16/92).2, Staphylococcus aureus were 100% of vancomycin and linezolid sensitivity rate (31/31) and 83.9% (26/31); Staphylococcus aureus to vancomycin and tigecycline susceptibility rate were 100% (20/20) and 85% (17/20). Pseudomonas aeruginosa were 72% sensitive to imipenem and Luo Peinan rate (18/25) and 84% (21/25); Bauman Acinetobacter to Amikacin, imipenem and meropenem sensitive rates were 75% (12/16), 81.3% (13/16) and 81.3%.3 (13/16), diabetic foot wound infection may be the influencing factors Logistic regression analysis showed that diabetes before 5 foot wound infection The influence factors were hypoproteinemia (OR=6.172, P=0.001), lower extremity vascular disease (OR=3.741, P=0.004), diabetic nephropathy (OR=2.685, P=0.002), diabetes (OR=2.324, P=0.004) and elevated glycated hemoglobin (OR=1.216, P=0.005). Conclusion: 1103 cases of patients with diabetic foot wound pathogen detection rate was 86.08%, 4 pathogenic bacteria were Staphylococcus aureus, Pseudomonas aeruginosa, Staphylococcus aureus and epidermal Bauman Acinetobacter, respectively 17.9%, 14.5%, 11.6% and 9.3%. gram positive bacteria accounted for 45.1%, the top 2 pathogens were Staphylococcus aureus 39.7% and Staphylococcus epidermidis 25.6%; gram negative bacteria accounted for 53.2%, before 2 to 27.2% of Pseudomonas aeruginosa and Acinetobacter Bauman 17.4%.2, Staphylococcus aureus were 100% and 83.9% for vancomycin and linezolid susceptibility; Staphylococcus epidermidis to vancomycin and tigecycline susceptibility rate were 100% 85.0%. and Pseudomonas aeruginosa were 72% and 84% for imipenem and meropenem susceptibility; Bauman Acinetobacter to Amikacin, imipenem and meropenem sensitivity rates were 75%, 81.3% and 81.3%.3, 5 diabetic foot wound infection factors according to the relative risk (OR) value as follows hypoproteinemia (6.172), lower extremity vascular disease (3.741), diabetic nephropathy (2.685), diabetes (2.324) and elevated glycated hemoglobin (1.216).

【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R587.2

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 林楚佳;郭佩湘;林嘉慧;林少達(dá);;糖尿病足患者臨床特點(diǎn)及皮膚組織學(xué)結(jié)構(gòu)改變[J];中國醫(yī)學(xué)創(chuàng)新;2017年02期

2 高婭;崔正軍;史迅;郭鵬飛;孟慶楠;楊高遠(yuǎn);楊榮強(qiáng);;經(jīng)皮腔內(nèi)血管成形術(shù)在糖尿病足患者外科治療中的應(yīng)用[J];中華燒傷雜志;2016年08期

3 鄭月宏;劉端;;糖尿病足血管病變的外科治療[J];中華糖尿病雜志;2016年07期

4 阿賽古麗;馬惠霞;張純;賀猛;;自體干細(xì)胞移植治療糖尿病足研究進(jìn)展[J];中國老年學(xué)雜志;2016年04期

5 孫琪;石露;蔣紅;胡興越;;神經(jīng)電生理技術(shù)在糖尿病周圍神經(jīng)病診斷中的聯(lián)合應(yīng)用[J];中華物理醫(yī)學(xué)與康復(fù)雜志;2015年11期

6 常翔;何泱;張杉杉;許蕾;顧雪明;顧俊義;湯正義;寧光;;糖尿病足潰瘍感染與病原菌種及敏感抗生素的關(guān)系[J];中華糖尿病雜志;2015年07期

7 胡驍驊;鄧微;陳忠;黎明;杜偉力;王成;王紅;沈余明;;糖尿病足創(chuàng)面的個性化處理[J];中華損傷與修復(fù)雜志(電子版);2015年02期

8 李強(qiáng);李海芹;逄濤;張素芳;王向陽;梅運(yùn)濤;;定量感覺檢測對2型糖尿病周圍神經(jīng)損傷的臨床觀察[J];臨床醫(yī)學(xué);2015年01期

9 廖雪玲;陳軍寧;李小勵;鄧特;鄧一嵐;謝旭;;整合素α2(ITGA2)-807C/T位點(diǎn)基因多態(tài)性與糖尿病腎病的相關(guān)性[J];實(shí)用醫(yī)學(xué)雜志;2014年16期

10 班繹娟;冉興無;楊川;王鵬華;馬建華;陳兵;于艷梅;馮波;陳莉麗;殷漢;成志峰;賈黎靜;閆朝麗;楊玉芝;劉芳;杜玉茗;毛季萍;肖正華;林少達(dá);趙n\;馬學(xué)毅;周迎生;陳國昌;卞茸文;許樟榮;;中國部分省市糖尿病足病臨床資料和住院費(fèi)用等比較[J];中華糖尿病雜志;2014年07期

，

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