国际呼吸杂志
國際呼吸雜誌
국제호흡잡지
INTERNATIONAL JOURNAL OF RESPIRATION
2013年
7期
503-507
,共5页
蔺兴娟%魏春华%王寒%杜秀伟%张翠翠%刘艳红%李国华%管华东%温明春
藺興娟%魏春華%王寒%杜秀偉%張翠翠%劉豔紅%李國華%管華東%溫明春
린흥연%위춘화%왕한%두수위%장취취%류염홍%리국화%관화동%온명춘
支气管肺泡灌洗液%病原菌%药敏%支气管扩张%支气管哮喘
支氣管肺泡灌洗液%病原菌%藥敏%支氣管擴張%支氣管哮喘
지기관폐포관세액%병원균%약민%지기관확장%지기관효천
Bronchoalveolar lavage fluid%Pathogens%Susceptibility%Bronchiectasis%Bronchial asthma
目的 探讨支气管肺泡灌洗液(bronchoalveolar lavage fluids,BALF)病原菌培养及药敏试验在支气管扩张症合并支气管哮喘治疗中的临床应用价值.方法 选择90例支气管扩张症合并支气管哮喘的住院患者,收集其BALF标本进行病原菌培养及药敏试验.结果 90例患者病原菌检出阳性55例(61.1%),共57株.革兰阴性杆菌54株(94.7%),以铜绿假单胞菌为主,鲍曼不动杆菌次之;真菌2株(3.5%),为曲霉菌;革兰阳性球菌1株(1.8%),为金黄色葡萄球菌.混合菌感染2例,为鲍曼不动杆菌合并金黄色葡萄球菌1例、施氏假单胞菌合并铜绿假单胞菌1例.药敏试验发现,53株革兰阴性杆菌对妥布霉素、头孢哌酮舒巴坦、亚胺培南最敏感,对头孢噻肟、复方新诺明、左旋左氧氟沙星耐药性最高;嗜麦芽寡养食单胞菌对左旋左氧氟沙星、米诺环素及复方新诺明100%敏感;曲霉菌对两性霉素B、伊曲康唑、伏立康唑100%敏感;革兰阳性球菌只检出1株,药敏结果代表性不强,未给予深入研究.结论 支气管扩张症合并支气管哮喘患者BALF病原菌培养出细菌以革兰阴性杆菌为主,真菌感染率亦显现,革兰阳性球菌少;2种或2种以上混合细菌感染虽然占少数,但混合菌感染的出现说明各病原菌对多种抗菌药物的耐药性可能增加;药敏结果对临床治疗支气管扩张症合并支气管哮喘有重要指导意义;BALF取样部位针对性强,提供结果较可靠,培养阳性率高,临床应用价值较大;通过肺泡灌洗将有助于支气管扩张症的感染性分泌物清除,改善患者支气管阻塞,降低局部病原菌数量和浓度,有助于改善其喘息症状,并有助于控制感染.
目的 探討支氣管肺泡灌洗液(bronchoalveolar lavage fluids,BALF)病原菌培養及藥敏試驗在支氣管擴張癥閤併支氣管哮喘治療中的臨床應用價值.方法 選擇90例支氣管擴張癥閤併支氣管哮喘的住院患者,收集其BALF標本進行病原菌培養及藥敏試驗.結果 90例患者病原菌檢齣暘性55例(61.1%),共57株.革蘭陰性桿菌54株(94.7%),以銅綠假單胞菌為主,鮑曼不動桿菌次之;真菌2株(3.5%),為麯黴菌;革蘭暘性毬菌1株(1.8%),為金黃色葡萄毬菌.混閤菌感染2例,為鮑曼不動桿菌閤併金黃色葡萄毬菌1例、施氏假單胞菌閤併銅綠假單胞菌1例.藥敏試驗髮現,53株革蘭陰性桿菌對妥佈黴素、頭孢哌酮舒巴坦、亞胺培南最敏感,對頭孢噻肟、複方新諾明、左鏇左氧氟沙星耐藥性最高;嗜麥芽寡養食單胞菌對左鏇左氧氟沙星、米諾環素及複方新諾明100%敏感;麯黴菌對兩性黴素B、伊麯康唑、伏立康唑100%敏感;革蘭暘性毬菌隻檢齣1株,藥敏結果代錶性不彊,未給予深入研究.結論 支氣管擴張癥閤併支氣管哮喘患者BALF病原菌培養齣細菌以革蘭陰性桿菌為主,真菌感染率亦顯現,革蘭暘性毬菌少;2種或2種以上混閤細菌感染雖然佔少數,但混閤菌感染的齣現說明各病原菌對多種抗菌藥物的耐藥性可能增加;藥敏結果對臨床治療支氣管擴張癥閤併支氣管哮喘有重要指導意義;BALF取樣部位針對性彊,提供結果較可靠,培養暘性率高,臨床應用價值較大;通過肺泡灌洗將有助于支氣管擴張癥的感染性分泌物清除,改善患者支氣管阻塞,降低跼部病原菌數量和濃度,有助于改善其喘息癥狀,併有助于控製感染.
목적 탐토지기관폐포관세액(bronchoalveolar lavage fluids,BALF)병원균배양급약민시험재지기관확장증합병지기관효천치료중적림상응용개치.방법 선택90례지기관확장증합병지기관효천적주원환자,수집기BALF표본진행병원균배양급약민시험.결과 90례환자병원균검출양성55례(61.1%),공57주.혁란음성간균54주(94.7%),이동록가단포균위주,포만불동간균차지;진균2주(3.5%),위곡매균;혁란양성구균1주(1.8%),위금황색포도구균.혼합균감염2례,위포만불동간균합병금황색포도구균1례、시씨가단포균합병동록가단포균1례.약민시험발현,53주혁란음성간균대타포매소、두포고동서파탄、아알배남최민감,대두포새우、복방신낙명、좌선좌양불사성내약성최고;기맥아과양식단포균대좌선좌양불사성、미낙배소급복방신낙명100%민감;곡매균대량성매소B、이곡강서、복립강서100%민감;혁란양성구균지검출1주,약민결과대표성불강,미급여심입연구.결론 지기관확장증합병지기관효천환자BALF병원균배양출세균이혁란음성간균위주,진균감염솔역현현,혁란양성구균소;2충혹2충이상혼합세균감염수연점소수,단혼합균감염적출현설명각병원균대다충항균약물적내약성가능증가;약민결과대림상치료지기관확장증합병지기관효천유중요지도의의;BALF취양부위침대성강,제공결과교가고,배양양성솔고,림상응용개치교대;통과폐포관세장유조우지기관확장증적감염성분비물청제,개선환자지기관조새,강저국부병원균수량화농도,유조우개선기천식증상,병유조우공제감염.
Objective To explore the clinical value of bronchoalveolar lavage fluid (BALF) pathogen culture and drug susceptibility testing in the treatment of bronchiectasis accompany with bronchial asthma.Methods Select 90 cases inpatients with bronchiectasis and bronchial asthma.Collect their BALF for pathogens culturing and antibiotic susceptibility testing.Results 55 of the 90 cases patients is positive in pathogen detection(61.1%),and 57 strains in all.54 strains Gram negative bacilli (94.7 %),mainly in P.aeruginosa,followed by Acinetobacter baumannii,2 strains fungi (3.5 %),both Aspergillus,1 strains Gram positive cocci (1.8%),Staphylococcus aureus.Two cases are mixed infection,Acinetobacter baumannii merging Staphylococcus aureus and Amur Pseudomonas merging Pseudomonas aeruginosa.Results of the Susceptibility test:53 strains Gram-negative bacilli are most sensitive to tobramycin,cefoperazone sulbactam,imipenem,and are most resistant to cefotaxime,cotrimoxazole,L levofloxacin,maltophilia oligotrophic food Aeromonas is 100% sensitive to Llevofloxacin,minocycline and cotrimoxazole,Aspergillus is 100% sensitive to amphotericin B,itraconazole,voriconazole,there is only 1 strains Gram-positive cocci,not deeply studied due to weak results of drug susceptibility.Conclusions The main pathogens cultured of BALF in patients with bronchiectasis accompany with bronchial are Gram-negative bacilli,fungal infection also reveals,and Gram positive cocci is less,although two kinds or more than two kinds of mixed bacterial irnfection is few,mixed culture infection is an indication of pathogens that a variety of antimicrobial agents may be increased,the results of drug sensitive for clinical treatment of bronchiectasis combined bronchial asthma have important guiding significance; there will be a larger clinical application value because of targeted sampling site,providing reliable results,and high cultivating positive rate.At the same time,bronchoalveolar lavage can help clear infectious secretion,improving bronchial obstruction and reducing local pathogen quantity and concentration,and also help improve their breathing symptoms and control the infection.