摘要
目的:了解我院近5年来慢性阻塞性肺疾病急性加重期(AECOPD)患者下呼吸道感染病原体分布及耐药情况,为临床抗菌药物的使用提供依据;探讨AECOPD患者下呼吸道感染相关发病因素及发病机制。方法:分析近5年我院确诊的AECOPD患者共1 354例,分成无创呼吸机治疗组、有创呼吸机治疗组、未上呼吸机治疗组3组,比较下呼吸道病原菌培养及药敏实验结果。根据AECOPD患者的临床特点进行分组,用卡方检验进行单因素分析,筛选出发病危险因素。结果:分离病原菌大部分为革兰氏阴性菌,占所有病原菌的56.45%,以铜绿假单胞菌、鲍曼不动杆菌、肺炎克雷伯菌为主;在革兰氏阳性菌中主要为肠球菌为主。单因素分析结果提示年龄、意识状态、住院时间、通气时间、有创操作、呼吸机及管路微生物感染与下呼吸道感染有关;与性别、预防应激性溃疡药物使用无关。结论:AECOPD患者呼吸道细菌产生耐药性的现象十分普遍,要求抗菌药物使用必须规范,以降低耐药病菌的出现。
Objective： To investigate the bacterial distribution, clinical features, drug sensitivity and risk factors of lower respiratory tract infection in patients with acute exacerbation of chronic obstructive pulmonary disease （AECOPD）, in order to provide treatment basis for critical and severe patients in fighting against infection. Methods：The data of 1354 patients with AECOPD in the Fourth Affiliated Hospital of Shihezi University between the year of 2010 to 2013 were analyzed retrospectively.All patients were divided into 3 groups：with noninvasive ventilator assisted ventilation group,without ventilator group and invasive ventilation group.The differences in pathogenic bacteria and their drug sensitivity were compared among different groups. Base on the clinical features in AECOPD Univariate Chi-square was conducted analysis of the markedly different factors in the two groups was employed in SPSS.Results：372 strains of pathogens were isolated,including 210 strains of gram-negative bacilli, 894strains of gram positive cocci and 68 strains of fungi.Among all the strains,Gram-negative bacteria accounted for 56.45% ,in which pseudomonas aeruginosa, acinetobacter baumannii, klebsiella pneumoniae were the major pathogens;Gram-positive baeteria accounted for 25.27%, in which enterococcus was the major pathogen.Chi-square analysis revealed that age,consciousness condition, stay, length of time for mechanical,Invasive procedure, microorgnism cononization in the tube of ventilator were independent risk factors involved in infection.Conclusion： The main pathogens of lower respiratory tract infection in patients with COPD are gram-negative bacilli, we should select the drugs reasonably according to the results of antimicrobial susceptibility test.
出处
《农垦医学》
2016年第1期54-58,共5页
Journal of Nongken Medicine
基金
新疆生产建设兵团第一师师市科研项目(2015YL-12)
关键词
慢性阻塞性肺疾病
病原体
耐药
Chronic obstructive pulmonary disease
Pathogens
Drug resistance
