CAJ | 학술논문

目的：探讨肺结核合并肺部感染的危险因素并分析其病原体特点。方法选取确诊肺结核患者158例。收集患者病历结合临床医师报告，由专门人员填写统一表格后采用回顾性分析统计肺结核患者肺部感染发生的危险因素。取患者新鲜痰液，经细菌分离和鉴定分析病原体特点。结果继发性肺结核、肺结核复治、痰涂片抗酸染色阴性、长期使用糖皮质激素、长期使用广谱抗生素、合并基础疾病作为自变量均为合并肺部感染的危险因素（OR值均≥2，P＜0．05）。病原学分析发现，革兰阳性菌、阴性菌、真菌分别占感染致病菌的25．95％、70．25％、3．86％。其中，肺炎克雷伯杆菌、铜绿假单胞菌及肺炎链球菌比例最高。药敏实试显示头孢吡肟（马斯平）敏感性最高（87．8％），复方磺胺甲噁唑耐药性最高（72．0％）。结论肺结核合并肺部感染的危险因素有：继发性肺结核、肺结核复治、痰涂片抗酸染色阴性、长期使用糖皮质激素、长期使用广谱抗生素、合并基础疾病。肺结核并发肺部感染的患者常规应用普通青霉素及一代和二代头孢类效果并不一定理想，应在药敏结果回报前考虑使用三代头孢、半合成青霉素、喹诺酮类及氨基苷类等敏感度高的药物。
목적：탐토폐결핵합병폐부감염적위험인소병분석기병원체특점。방법선취학진폐결핵환자158례。수집환자병력결합림상의사보고，유전문인원전사통일표격후채용회고성분석통계폐결핵환자폐부감염발생적위험인소。취환자신선담액，경세균분리화감정분석병원체특점。결과계발성폐결핵、폐결핵복치、담도편항산염색음성、장기사용당피질격소、장기사용엄보항생소、합병기출질병작위자변량균위합병폐부감염적위험인소（OR치균≥2，P＜0．05）。병원학분석발현，혁란양성균、음성균、진균분별점감염치병균적25．95％、70．25％、3．86％。기중，폐염극뢰백간균、동록가단포균급폐염련구균비례최고。약민실시현시두포필우（마사평）민감성최고（87．8％），복방광알갑오서내약성최고（72．0％）。결론폐결핵합병폐부감염적위험인소유：계발성폐결핵、폐결핵복치、담도편항산염색음성、장기사용당피질격소、장기사용엄보항생소、합병기출질병。폐결핵병발폐부감염적환자상규응용보통청매소급일대화이대두포류효과병불일정이상，응재약민결과회보전고필사용삼대두포、반합성청매소、규낙동류급안기감류등민감도고적약물。
Objective To explore the risk factors of pulmonary tuberculosis complicated with pulmonary in-fection and to analyze the pathogens characteristics.Methods 158 patients diagnosed with tuberculosis were chosen. patient medical records with clinicians report were collected,risk factors of pulmonary tuberculosis in patients with pulmonary infection were analyzed by statistical review of specialized personnel to fill in the unified form.With the characteristics of fresh sputum,pathogen isolation and identification of bacteria were analyzed.Results Secondary pulmonary tuberculosis,pulmonary tuberculosis retreatment,acid fast sputum smear staining was negative,long-term use of glucocorticoid,long-term use of broad-spectrum antibiotics,with basic diseases as the variables were associ-ated with risk factors of pulmonary infection,there were statistically significant (P <0.05 ).Etiological analysis showed that gram positive bacteria,gram negative bacteria,fungi accounted for pathogens,70.25%,3.86%,25.95%. Among them,Klebsiella pneumoniae,Pseudomonas aeruginosa and Streptococcus pneumoniae accounted for the high-est proportion.Drug sensitive test showed cefepime(Ma Siping)the highest sensitivity(87.80%),compound sulfame-thoxazole were the most resistance(72.00%).Conclusion Pulmonary tuberculosis complicated with pulmonary in-fection risk factors were:Pulmonary tuberculosis,pulmonary tuberculosis retreatment,acid fast sputum smear staining was negative,long-term use of glucocorticoid,long-term use of broad-spectrum antibiotics,with basic diseases. Patients of routine application of penicillin and cephalosporin effect of pulmonary tuberculosis complicated with pulmo-nary infection is not necessarily ideal.It should be given to drug use three generation cephalosporins,quinolones and aminoglycosides,such as high sensitivity in drug sensitivity results back to front.