尿源性脓毒血症诊治分析(1)
摘 要：目的 總结尿源性脓毒血症的诊治经验，提高对尿源性脓毒血症的认识。方法 回顾性分析北京怀柔医院2017年3月～2018年8月临床确诊的9例尿源性脓毒血症患者的临床资料，按照就诊是否及时分为及时诊断组、延迟诊断组，观察两组患者血白细胞、血嗜酸性粒细胞、血小板、血乳酸及降钙素原变化情况。结果 9例患者中，女性7例(77.78%)，男性2例(22.22%);>60岁的6例(66.67%);3例(33.33%)患者合并有糖尿病，且血糖控制不佳，其中2例患者同时合并有糖尿病及慢性肾功能不全;均有发热症状，2例在确诊时血WBC下降，7例血WBC升高。3例患者出现诊断延迟，6例诊断及时。延迟诊断组患者就诊时均未行PCT检查，2例查血乳酸升高，未引起临床重视;与治疗前比较，患者WBC水平降低，EOS及血小板水平升高，差异有统计学意义(P<0.05)。4例尿培养阳性(阳性率44.44%)，其中3例为大肠埃希菌，1例为肺炎克雷伯杆菌。经积极治疗，所有患者均好转出院，未出现死亡病例。结论 老年女性合并有糖尿病或慢性肾功能不全是尿源性脓毒血症的高危因素;对于出现高热或低体温血WBC未见明显升高或降低患者，需完善PCT及血乳酸检查，EOS、乳酸及PCT值对早期诊断有一定价值;尿源脓毒血症进展迅速，需综合治疗，甚至需多科室协作，避免出现不良并发症。
, 百拇医药
关键词：尿源性脓毒血症;白细胞;血嗜酸性粒细胞;糖尿病;肾功能不全
中图分类号：R691.4 文献标识码：B DOI：10.3969/j.issn.1006-1959.2018.24.052
文章编号：1006-1959(2018)24-0170-03
Abstract：bjective To summarize the experience of diagnosis and treatment of urinary sepsis and improve the understanding of urinary sepsis. Methods The clinical data of 9 patients with urinary sepsis who were clinically diagnosed from March 2017 to August 2018 in Beijing Huairou Hospital were retrospectively analyzed. According to the timely treatment， the patients were divided into timely diagnosis group and delayed diagnosis group. Changes in blood leukocytes， blood eosinophils， platelets， blood lactate， and procalcitonin in patients. Results Of the 9 patients， 7 (77.78%) were female， 2 (22.22%) were male; 6 (66.67%) were >60 years old; 3 (33.33%) patients had diabetes and poor glycemic control. 2 of the patients had diabetes and chronic renal insufficiency at the same time; all had fever symptoms， 2 patients had decreased blood WBC at the time of diagnosis， and 7 patients had elevated blood WBC. Three patients had a delayed diagnosis and six were diagnosed promptly. Patients in the delayed diagnosis group did not undergo PCT examination at the time of treatment， and 2 patients had elevated blood lactate levels， which did not cause clinical attention. Compared with before treatment， patients' WBC levels decreased， EOS and platelet levels increased，the difference was statistically significant (P<0.05). 4 cases were positive for urine culture (positive rate 44.44%)， of which 3 cases were Escherichia coli and 1 case was Klebsiella pneumoniae. After active treatment， all patients were discharged and no deaths occurred. Conclusion Older women with diabetes or chronic renal insufficiency are risk factors for urinary sepsis. For patients with high fever or hypothermia without significant increase or decrease in WBC， PCT and blood lactate tests， EOS， should be improved. Lactic acid and PCT valueshave certain value for early diagnosis; urinary sepsis is rapidly progressing， requiring comprehensive treatment， and even multi-disciplinary collaboration is needed to avoid adverse complications., 百拇医药(韦能宝 薛志刚 毕金文)
, 百拇医药
关键词：尿源性脓毒血症;白细胞;血嗜酸性粒细胞;糖尿病;肾功能不全
中图分类号：R691.4 文献标识码：B DOI：10.3969/j.issn.1006-1959.2018.24.052
文章编号：1006-1959(2018)24-0170-03
Abstract：bjective To summarize the experience of diagnosis and treatment of urinary sepsis and improve the understanding of urinary sepsis. Methods The clinical data of 9 patients with urinary sepsis who were clinically diagnosed from March 2017 to August 2018 in Beijing Huairou Hospital were retrospectively analyzed. According to the timely treatment， the patients were divided into timely diagnosis group and delayed diagnosis group. Changes in blood leukocytes， blood eosinophils， platelets， blood lactate， and procalcitonin in patients. Results Of the 9 patients， 7 (77.78%) were female， 2 (22.22%) were male; 6 (66.67%) were >60 years old; 3 (33.33%) patients had diabetes and poor glycemic control. 2 of the patients had diabetes and chronic renal insufficiency at the same time; all had fever symptoms， 2 patients had decreased blood WBC at the time of diagnosis， and 7 patients had elevated blood WBC. Three patients had a delayed diagnosis and six were diagnosed promptly. Patients in the delayed diagnosis group did not undergo PCT examination at the time of treatment， and 2 patients had elevated blood lactate levels， which did not cause clinical attention. Compared with before treatment， patients' WBC levels decreased， EOS and platelet levels increased，the difference was statistically significant (P<0.05). 4 cases were positive for urine culture (positive rate 44.44%)， of which 3 cases were Escherichia coli and 1 case was Klebsiella pneumoniae. After active treatment， all patients were discharged and no deaths occurred. Conclusion Older women with diabetes or chronic renal insufficiency are risk factors for urinary sepsis. For patients with high fever or hypothermia without significant increase or decrease in WBC， PCT and blood lactate tests， EOS， should be improved. Lactic acid and PCT valueshave certain value for early diagnosis; urinary sepsis is rapidly progressing， requiring comprehensive treatment， and even multi-disciplinary collaboration is needed to avoid adverse complications., 百拇医药(韦能宝 薛志刚 毕金文)