不同血糖水平的尿源性脓毒血症患者临床特征分析

Clinical characteristics of uroseptic patients with different glycemic control levels

目的探讨不同血糖水平的尿源性脓毒血症患者临床特点,提高诊疗水平,降低高危重症患者的病死率。方法回顾性研究2012年1月至2018年1月在本院收治的66例上尿路结石伴尿源性脓毒血症患者的临床资料,根据糖化血红蛋白(HgA1c)水平将其分为血糖正常(非糖尿病)组,血糖控制良好(HgA1c<7.7%)组,血糖控制不好(HgA1c≥7.7%)组。通过对比重症感染患者在各组中所占比例,分析血糖控制情况对脓毒血症进展的影响。通过各组患者的一般情况、临床表现、实验室数据、合并疾病等数据进行对比,分析不同血糖水平患者的特征性临床表现和实验室指标。结果非糖尿病组、HgA1c<7.7%组、HgA1c≥7.7%组发生重症感染的比例分别为8%(3/40)、11%(2/18)、50%(4/8),HgA1c≥7.7%组更容易发生重症感染(P<0.05);各组患者在神志改变(0%、0%、25%)、血小板减少[(189±71)、(174±64)、(107±80)×109/L]、肾功能不全(2.5%、17.0%、38.0%)等参数的比较上差异有统计学意义(P<0.05)。各组患者在年龄、性别、结石负荷、肾积水程度、血色素、纤维蛋白原、血尿培养阳性等临床参数比较后差异无统计学意义(P>0.05),在腰腹部疼痛、恶心呕吐、发热、尿路刺激症状等临床表现的比较差异无统计学意义(P>0.05)。结论血糖控制不好的尿源性脓毒血症患者更容易发生重症感染,神志改变、血小板减少、肾功能不全是该群体患者的特征性临床表现。如果在临床工作中发现患者出现上诉症状,应重视并及早进行支持治疗及外科引流,这样可有助于降低该病的病死率。

Objective To investigate the clinical characteristics of uroseptic patients with different glycemic control levels,and to improve our diagnostic levels and decrease the mortality of severe urosepsis.Methods A retrospective study of clinical data of 66 uroseptic patients with urolithiasis from January 2012 to January 2018 was done.Based on the HgA1c,all patients into the nondiabetic group,the low HgA1c group(HgA1c<7.7%)and the high HgA1c group(HgA1c≥7.7%)group.By comparing the proportions of severe sepsis patients in these groups,the influence of glycemic control level on uroseptic patients was evaluated.The parameters of uroseptic patients including clinical symptoms,laboratory data and comorbidities were taken to evaluate the clinical characteristics and risk factors in different glycemic control level groups.Results The proportions of severe sepsis patients in these groups were 8%(nondiabetic)vs.11%(HgA1c<7.7%)vs.50%(HgA1c≥7.7%).Patients in high HgA1c group were more likely than others evere sepsis(P<0.05).There were significantly different in unconscious state(0 vs.0 vs.25%),renal failure(2.5%vs.17.0%vs.38.0%),thrombopenia[(189±71)vs.(174±64)vs.(107±80)]cases between these groups.There were no statistically significances in comparing parameters such as age,gender,stone burden,hydronephrosis,hemoglobin,fibrinogen,blood culture and urine culture of these groups.There were no statistically significances in clinical sypmtoms including abdominal pain,vomit,fever and dysuria between these groups(P>0.05).Conclusions The uroseptic patients with poor glycemic control are more likely to develop into critically ill state.The parameters of unconscious state,renal failure and thrombopenia are the characteristics of the uroseptic patients with poor glycemic control.If we find the diabetic patients emerging these symptoms,we should pay more attention and make the drainages immediately if necessary,to decrease the motality of urosepsis.