老年糖尿病合并肺部感染65例分析

目的探讨老年糖尿病患者合并肺部感染的临床特点,探讨其治疗策略。方法回顾性分析65例老年糖尿病合并肺部感染的患者的临床资料。结果有咳嗽、咳痰、发热等呼吸道症状58%,白细胞计数>1.0×109/L的占40%,无呼吸道症状的占38%,但肺部听诊可闻及肺部啰音,占86%,X线胸片均可发现肺部病灶。51例行血液流变学检查,其中78%存在血液粘度升高。痰培养结果多为G-杆菌。其中使用胰岛素治疗者56例。经治疗后,52例好转,13例死亡。结论老年糖尿病患者多存在血液粘度增高,致肺功能受损,易合并肺部感染。痰培养以多重耐药的G-杆菌为多,抗感染经验用药注意覆盖G-杆菌,然后按药敏结果选用抗生素治疗。

Objective To investigate the clinical features of elderly diabetes mellitus （DM） complicated by pneumonic infection and to explore the treatment tactics. Methods Retrospective analysis was taken for 65 aged patients with diabetes mellitus complicated by pneumonic infections. Results 58% patients had cough, expectorations and fever, 40% patients＇ WBC 〉 1.0 × 10^9/L, 38% patients had not respiratory symptoms, but 86% patients had rales on auscultation of lung. All had shadow in the lungs in X-ray film. 51 cases checked blood viscosity, 78 % arised. The case of gram-negative bacterium in sputum cultivation is mostly seen. 56 patients treated by insulin. After treatment 52 cases were cured and 13 cases died. Conclusion Elderly diabetes mellitus （ DM ） trend to complicate pneumonic infection for impaired lung function with increased blood viscosity. The case of multidrug-resistant gram-negative bacterium in sputum cultivation is most1 seen, Empirical use of antibiotics must cover gram-negative bacterium, then select antibiotics by drug-sensitive-tes results.