CAJ | 학술논문

目的分析煤工尘肺并发下呼吸道感染病原菌和耐药情况,为临床治疗提供依据.方法将对2009年1月至2010年lO月住院治疗的111例煤工尘肺并发感染患者分为行机械通气组(36例)和未行机械通气组(75例).两组患者均经纤维支气管镜(纤支镜)防污染毛刷取得下呼吸道标本进行病原菌分离培养鉴定及药敏试验.结果未行机械通气组病原菌检出率为46.7%(35/75),机械通气组为88.9%(32/36),机械通气组病原菌检出率明显高于未行机械通气组,差异有统计学意义(P＜0.01).未行机械通气组检出结核杆菌3例,G-杆菌27株,G+球菌3株,真菌2株;机械通气组检出G-杆菌26株,G+球菌3株,真菌3株.行机械通气组G-杆菌耐药率(78.8%)高于未行机械通气组(47.1%),差异有统计学意义(P＜0.05).结论煤工尘肺并发呼吸道感染的病原菌以G-杆菌为主,耐药现象严重,行机械通气组较未行机械通气组更严重.
목적 분석매공진폐병발하호흡도감염병원균화내약정황,위림상치료제공의거.방법 장대2009년1월지2010년lO월주원치료적111례매공진폐병발감염환자분위행궤계통기조(36례)화미행궤계통기조(75례).량조환자균경섬유지기관경(섬지경)방오염모쇄취득하호흡도표본진행병원균분리배양감정급약민시험.결과 미행궤계통기조병원균검출솔위46.7%(35/75),궤계통기조위88.9%(32/36),궤계통기조병원균검출솔명현고우미행궤계통기조,차이유통계학의의(P＜0.01).미행궤계통기조검출결핵간균3례,G-간균27주,G+구균3주,진균2주;궤계통기조검출G-간균26주,G+구균3주,진균3주.행궤계통기조G-간균내약솔(78.8%)고우미행궤계통기조(47.1%),차이유통계학의의(P＜0.05).결론 매공진폐병발호흡도감염적병원균이G-간균위주,내약현상엄중,행궤계통기조교미행궤계통기조경엄중.
Objective To investigate the composition and resistance of main pathogens isolated form Lower respiratory tract in coalminer s pneumoconiosis patients complicated with infection to provide the basis for clinical treatment. Method Coalminer's pneumoconiosis patients complicated with infection during 2009to 2010 were divided into mechanical ventilation group and non mechanical ventilation group. Specimens were obtained from lower respiratory tract by fibrobronchoscopy with protected specimen brush in patients of both groups to perform isolation, culture, identification and susceptibility test of pathogen. Result Total 111patients were enrolled, 36 of them in mechanical ventilation group and 75 patients in non mechanical ventilation group. The pathogenic bacteria detection rate of patients in mechanical ventilation group was significantly higher than that of patients in non mechanical ventilation group( 88.9% vs. 46.7%, P＜0.01). In non mechanical ventilation group, Mycobacterium tuberculosis was detected in 3 patients, and 27 strains of G- bacilli, 3 strains of G+ coccus, and 2 strains of fungus; and 26 strains of G- bacilli, 3 strains of G+ coccus, and 3 strains of fungus were detected in mechanical ventilation group. There was no significant difference in term of strains between the two groups (P＞0.05). Rate of resistance to main antibiotics of patients in mechanical ventilation group was higher than that of patients in non mechanical ventilation group. Conclusion Resistance of pathogenic bacteria isolated from lower respiratory tract was severe in coalminer's pneumoconiosis patients complicated with infection, which was higher in patients treated with mechanical ventilation than patients without mechanical ventilation. Mycobacterium tuberculosis and fungal infection and increasing resistance prompted that clinicians must attach importance to rational drug use and keep to monitoring bacterial resistance.