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目的分析糖尿病酮症酸中毒合并院内获得性肺炎的感染危险因素,为临床预防其发生提供方法。方法对2006年1月-2010年12月入住我院内科病房的237例糖尿病酮症酸中毒患者进行回顾性研究,其中186例合并院内获得性肺炎;结合痰培养及药敏试验,对其中可能的多项致病危险因素进行分析。结果糖尿病酮症酸中毒患者并发院内获得性肺炎的主要危险因素有意识状态、住院日、气管切开、鼻饲胃管及肺部基础疾病。共培养出病原菌165株,革兰阴性杆菌与革兰阳性球菌分别占50.91%和44.24%。革兰阴性杆菌中以克雷伯菌属、大肠埃希菌和铜绿假单胞菌为主,对亚胺培南/西司他汀、哌拉西林/三唑巴坦、含有内酰胺酶抑治剂的头孢哌酮舒巴坦较敏感;革兰阳性菌中以金黄色葡萄球菌为主,对万古霉素均敏感。结论在糖尿病酮症酸中毒的诊治过程中,加强对这些医院感染危险因素的处理,可能是减少院内获得性肺炎发生的主要措施。
Objective To analyze the risk factors of nosocomial pneumonia in patients with diabetic ketoacidosis and provide a method for clinical prevention. Methods A retrospective study was performed on 237 patients with diabetic ketoacidosis admitted to our wards from January 2006 to December 2010, 186 of whom had acquired pneumonia. Combined with sputum culture and drug sensitivity test, The number of risk factors for the analysis. Results The main risk factors of nosocomial pneumonia in patients with diabetic ketoacidosis were conscious status, hospitalization days, tracheotomy, nasogastric tube and underlying lung diseases. A total of 165 pathogenic bacteria were co-cultivated, with Gram-negative bacilli and Gram-positive cocci accounting for 50.91% and 44.24% respectively. Gram-negative bacilli in Klebsiella, Escherichia coli and Pseudomonas aeruginosa mainly imipenem / cilastatin, piperacillin / tazobactam, containing lactamase inhibition Cefoperazone sulbactam is more sensitive; Gram-positive Staphylococcus aureus-based, are sensitive to vancomycin. Conclusions In the diagnosis and treatment of diabetic ketoacidosis, strengthening the management of risk factors for these nosocomial infections may be the main measure to reduce the incidence of nosocomial pneumonia.