Many such patients are admitted to ICU every year, and they have some common characteristics.
Basic information: female, elderly, with a history of diabetes. (There are also women who, though not very old, have a long history of diabetes.)
Features of morbidity: fever, vomiting, abdominal pain; with or without urgency, frequency of urination, pain in urination; in severe cases, confusion, decreased blood pressure (need to use pressor drugs), decreased urine volume, expiratory dyspnoea (in severe cases, need to use ventilator-assisted correction of hypoxia).
Laboratory examination: high blood sugar (some blood sugar is not high), urine routine shows increased white blood cell count, high infection indicators (white blood cell count, C-reactive protein, procalcitonin, interleukin-6, etc.), elevated blood lactic acid, severe thrombocytopenia, elevated serum creatinine, elevated bilirubin, abnormal coagulation function, blood gas analysis shows that oxygen partial pressure is significantly lower than normal, metabolic acidosis.
A well-trained ICU doctor, seeing such a patient, combined with these clinical and laboratory data, can make an accurate and decisive diagnosis: sepsis! (There used to be the term septicemia.)
Infection + organ damage = sepsis!
The first source of infection is the urinary system, of course, there are also some patients with other parts of the infection, such as the lungs.
A well-trained ICU doctor, after the diagnosis of sepsis, will immediately start the cluster treatment strategy, race against time to save lives: fluid infusion, pressure rise, application of powerful broad-spectrum antibiotics, correction of shock, control of blood sugar, and complete etiological examination: blood culture, urine culture, and sputum culture if necessary.
The implementation of cluster therapy strategy can greatly improve the success rate of sepsis patients.
With the stabilization of vital signs, the results of etiological tests will be reported one after another.
The same bacteria were cultured in blood and midstream urine, most of which were Enterobacteriaceae, followed by other bacteria such as Enterococcus. Further confirmation of urinary tract infection, bacteria into the blood, leading to sepsis, and even septic shock.
Septic shock is the primary disease in ICU, and the mortality rate is as high as 50%!
So why are elderly diabetic women prone to urinary tract infections and sepsis?
There are several reasons:
1, the physiology characteristic of female itself: Urethra is shorter, angle is flatter, straight, be adjacent with the vagina, very easy by department of gynaecology and outside Bacterial infection of the pudendum, invasion of the urethra, bladder, retrograde infection. 2. After childbirth, women will have different degrees of pelvic floor muscle relaxation, resulting in urethral downward movement, bladder bulge of different degrees, resulting in increased residual urine in the bladder, if not emptied in time, it is easy to cause infection. 3. After menopause, the estrogen level of women decreases. After losing the protection of estrogen, the mucosa atrophies and the defense ability decreases. Once infection occurs, the symptoms are easy to repeat, the condition is prolonged or even deteriorated. 4. Due to the increase of blood sugar and urine sugar in diabetic patients, the high sugar environment of urinary tract is more conducive to bacterial growth. In addition, diabetes leads to impaired immunity and mucosal barrier function, which makes it easier for bacteria to enter the blood and cause sepsis. 5. If there are obstructive factors such as urinary calculi and tumors, the incidence of urinary tract infection is higher, and the obstruction should be relieved as soon as possible by drug treatment. 6. If they are bedridden and incontinent, they are more likely to suffer from retrograde urinary tract infection, which can lead to sepsis. For the above reasons, elderly diabetic women are prone to sepsis caused by urinary tract infection. Only by early identification, clear diagnosis and standardized treatment can success rate of cure be improved. For elderly women with diabetes, the key points of prevention should be kept in mind: 1. Local cleaning, especially for bedridden patients; 2. Strengthen blood sugar monitoring and control blood sugar to reach the standard. Sepsis with septic shock
