糖尿病与非糖尿病患者口腔颌面部间隙感染的临床特征及治疗结果比较

Comparison of clinical characteristics and treatment results of oral maxillofacial space infection in diabetic and non-diabetic patients

目的比较糖尿病与非糖尿病患者口腔颌面部间隙感染的临床特征。方法选取2017年2月至2020年2月本院口腔颌面外科收治的72例口腔颌面部间隙感染患者作为研究对象,均给予对症支持治疗,根据是否合并糖尿病分为糖尿病组(n=29)和非糖尿病组(n=43)。分析感染原因、感染间隙,比较两组实验室检查指标、感染细菌分布、临床表现及治疗结果。结果72例感染患者中,牙源性感染最多,占比66.7%,其次为腺源性,占比15.3%;两组感染原因比较差异无统计学意义。72例感染患者中,颌下间隙感染最多,占比37.5%,其次为颊间隙,占比31.9%;两组感染间隙比较差异无统计学意义。糖尿病组入院时空腹血糖水平明显高于非糖尿病组,差异有统计学意义(P<0.05);两组入院时白细胞计数和中性粒细胞百分比比较差异无统计学意义。72例感染患者中,行脓肿切开51例,占比70.8%;其中糖尿病组占比65.5%,非糖尿病组占比74.4%,两组脓肿切开占比比较差异无统计学意义。51例脓肿切开患者中,检出感染细菌30例,检出率58.8%;感染细菌以链球菌为主,占比25.5%。糖尿病组感染细菌12例,占比40.0%,其中耐甲氧西林金黄色葡萄球菌(MRSA)感染占比最多(21.1%);非糖尿病组感染细菌18例,咽峡链球菌感染占比最多(15.6%);两组感染细菌分布情况比较差异均无统计学意义。糖尿病组感染累计间隙多于非糖尿病组,颌面部肿胀范围大于非糖尿病组,差异有统计学意义(P<0.05)。糖尿病组住院时间长于非糖尿病组,差异有统计学意义(P<0.05);两组呼吸道梗阻、纵隔炎发生率比较差异无统计学意义。结论口腔颌面部感染合并糖尿病时,患者颌面部感染程度更重、住院时间更长且并发症更多,给予合理治疗可控制感染,避免并发症的发生。

Objebtive To compare the clinical characteristics of oral maxillofacial space infection in diabetic and non-diabetic patients.Methods A total of 72 patients with oral maxillofacial space infection admitted to the department of Oral and Maxillofacial Surgery of our hospital from February 2017 to February 2020 were selected as the study subjects,and they were given symptomatic supportive treatment,and they were divided into diabetic group(n=29)and non-diabetic group(n=43)according to whether they were complicated with diabetes.The causes and space of infection were analyzed,and the laboratory indexes,distribution of pathogenic bacteria,clinical manifestations and treatment results were compared between the two groups.Results Among the 72 patients with infected,odontogenic infection was the most common,accounting for 66.7%,followed by adenogenic infection,accounting for 15.3%,but there was no significant difference in the cause of infection between the two groups.Among the 72 patients,submaxillary space was the most infected,accounting for 37.5%,followed by buccal space,accounting for 31.9%;there was no significant difference in infection space between the two groups.The level of fasting blood glucose on admission in the diabetic group was significantly higher than that in the non-diabetic group,and the difference was statistically significant(P<0.05).There was no significant difference in white blood cell count and neutrophil percentage on admission between the two groups.Among the 72 patients with infection,51 cases underwent abscess incision,accounting for 70.8%;among them,the diabetic group accounted for 65.5%and the non-diabetic group accounted for 74.4%,but there was no statistical significance in the proportion of abscess incision between the two groups.Among 51 patients with abscess incision,30 cases were detected with infectious bacteria,the detection rate was 58.8%;Streptococcus was the main infected bacteria,accounting for 25.5%.In the diabetes group,12 cases were infected with bacteria,accounting for 40.0%,among which methicillin-resistant Staphylococcus aureus(MRSA)infection accounted for the most proportion was 21.1%.In the non-diabetic group,18 cases were infected with bacteria,and the angina streptococcus infection accounted for the most proportion was 15.6%;there was no significant difference in the distribution of infected bacteria between the two groups.The accumulated space of infection in the diabetic group was higher than that in the non-diabetic group,and the range of maxillofacial swelling was higher than that in the non-diabetic group,the differences were statistically significant(P<0.05).The length of hospital stay in the diabetic group was significantly longer than that in the non-diabetic group,the difference was statistically significant(P<0.05).There was no significant difference in the incidence of respiratory tract obstruction and mediastinitis between the two groups.Conclusion When oral and maxillofacial infection combined with diabetes,the degree of maxillofacial infection is more severe,the hospital stay is longer and the complications are more,reasonable treatment can control the infection and avoid the occurrence of complications.