Diagnosis And Treatment Of Oral And Maxillofacial Space Infection Complicated With Hyperglycemia

Objective: To study the epidemiological characteristics of patients with oral and maxillofacial space infection(OMSI)complicated with hyperglycemia,and to explore the effects of hyperglycemia environment on the course of disease,complications and pathogens of OMSI patients,so as to improve the clinical awareness of OMSI patients with hyperglycemia,especially to pay more attention to OMSI patients with non-diabetic hyperglycemia.To provide some theoretical basis for clinicians in the process of diagnosis and treatment in the future.Methods: The data of 158 patients with OMSI who meet the statistical conditions in the Department of Oral and Maxillofacial surgery of the first affiliated Hospital of Dalian Medical University from October 2012 to September 2019 were collected and divided into diabetic group and non-diabetic group according to their diabetes or not.According to the level of glucose metabolism,the non-diabetic group was further divided into three groups: impaired glucose regulation group,stress hyperglycemia group,and normal blood glucose group as the control group.The epidemiological data,source of infection,site involved,related laboratory indexes,hospitalization days and expenses,infection pathogens and drug sensitivity test results of the four groups were analyzed and compared.Statistical analysis was carried out by statistical software SPSS.21.0,in which the measurement data were described by mean±standard deviation(?),t-test was used for the comparison between the two groups,variance analysis was used for the comparison between multiple groups,and ? 2 test was used for the counting data.The statistical results showed that the difference was statistically significant(P <0.05).Results: 1.Epidemiological characteristics:(1)according to the statistics,a total of 158 patients with OMSI meet the statistical conditions of this study,including 46 patients in diabetes group and 112 patients in non-diabetic group,including impaired glucose regulation group(n=21),stress hyperglycemia group(n=25)and normal blood glucose group(n=66).Most of the patients were over 60 years old,with a total of 57 cases,accounting for about 36.08%.The average age of patients with hyperglycemia was generally high,among which the average age of patients with diabetes was the highest(61.33±13.14),followed by stress hyperglycemia(60.76±12.95),impaired glucose regulation(52.90±18.27).(2)in the comparison of the social occupation composition of patients,the number of unemployed persons is the largest,accounting for about 29.75%,followed by staff,33 cases,accounting for about 20.89%.Among retirees,the proportion of patients with hyperglycemia is higher,about 78.57%.(3)about 47.83% of the patients in the diabetic group chose to see a doctor within 7 days after the onset of symptoms,while most of the patients in the non-diabetic group visited the doctor 7days after the onset of the disease.A total of 89 patients had irregular use of antibiotics before treatment,accounting for about 56.33%.(4)odontogenic infection is the main source of infection in patients with OMSI,accounting for 50% or more in each group.2.The effect of hyperglycemia on OMSI:(1)among the 158 patients with OMSI,there were 67 cases of single space infection,of which the submandibular space was the most frequently involved,and 91 cases of multi-space infection,among which the diabetes group had the highest incidence of multi-space infection,about 65.22%,followed by stress hyperglycemia group,impaired glucose regulation group and normal blood glucose group,and the incidence of multi-space infection was 64.00%,57.14%and 50%,respectively.(2)the average hospital stay in diabetes group was the highest in each group,about(16.48±9.89)days,followed by stress hyperglycemia group,(12.80±5.94)days.In the comparison of the average hospitalization cost,the average hospitalization cost in the diabetes group was also the highest,about(1.83±1.70)million yuan,followed by the stress hyperglycemia group,about(1.39±0.56)million yuan.(3)the average leukocyte and neutrophil count in each group were compared,and the values of the three hyperglycemia groups were higher than those of the normal blood glucose group.The average value of glycosylated hemoglobin was the highest in diabetic group(9.78±3.12)% and(5.80±0.36)% in stress hyperglycemia group,which was the highest in non-diabetic group.(4)the most commonly detected pathogen was G+ streptococcus,accounting for about 40.78%.Klebsiella pneumoniae accounted for about 51.52% of the strains detected in the diabetic group,which was the main pathogen of infection;in the non-diabetic group,the main infectious bacteria were G +streptococcus,accounting for about 48.57%;and in the stress hyperglycemia group,the detection rate of Klebsiella pneumoniae was higher than that in the normal blood glucose group and impaired glucose regulation group,accounting for about 33.33%.3.The effect of the change of blood glucose value on the condition of OMSI in stress hyperglycemia group: in the stress hyperglycemia group,with the increase of blood glucose value of 1 mmol / L,the corresponding average white blood cell and neutrophil count,average hemoglobin value,hospitalization days and hospitalization expenses increased,and the incidence of multi-space infection and the proportion of serious complications also increased.Conclusion: 1.The main disease groups of OMSI are the elderly and the unemployed,and the odontogenic infection is the main source of infection.The infection in single space is most often involved in the submandibular space,and the most common pathogen detected is G + streptococci.It is common to delay medical treatment and irregular use of antibiotics.2.The difference in the development and outcome of the disease between the impaired glucose regulation group and the normal blood glucose group has a certain clinical significance.The monitoring of their blood glucose should be strengthened and consult the relevant departments if necessary to prevent the possible adverse consequences of further increase of blood glucose value.3.Stress hyperglycemia and diabetes are both risk factors for the aggravation of OMSI.Stress hyperglycemia is not uncommon in patients with OMSI,and it is closer to the diabetic group in the incidence of multi-space infection,the proportion of serious complications and the detection rate of Klebsiella pneumoniae.The increase of blood glucose value was positively correlated with the severity of infection,hospitalization time and cost,which increased the difficulty of treatment.Clinical workers should strengthen their understanding of this kind of non-diabetic patients with hyperglycemia,improve the accuracy of their diagnosis,closely monitor blood glucose,and actively work out individual hyperglycemia treatment programs in conjunction with endocrinology departments while anti-infective treatment.so as to improve the overall prognosis of the patients.